Healthcare Provider Details

I. General information

NPI: 1013684901
Provider Name (Legal Business Name): BODHI COUNSELING & CONSULTING CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TRADE CENTRE DR STE 302
CHAMPAIGN IL
61820-7233
US

IV. Provider business mailing address

212 E MARSHALL ST
TOLONO IL
61880-9549
US

V. Phone/Fax

Practice location:
  • Phone: 217-731-4638
  • Fax:
Mailing address:
  • Phone: 217-731-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELANIE SIVLEY
Title or Position: OWNER
Credential: LCWS
Phone: 217-731-4638