Healthcare Provider Details

I. General information

NPI: 1053452599
Provider Name (Legal Business Name): KRISTI RAE KINNEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14671 N. COURT 5
EFFINGHAM IL
62401
US

IV. Provider business mailing address

14671 N. COURT 5
EFFINGHAM IL
62401
US

V. Phone/Fax

Practice location:
  • Phone: 217-868-5862
  • Fax: 217-868-5739
Mailing address:
  • Phone: 217-868-5862
  • Fax: 217-868-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-003504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: