Healthcare Provider Details

I. General information

NPI: 1477389716
Provider Name (Legal Business Name): SOPHRON COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E COURT ST STE 710
KANKAKEE IL
60901-3845
US

IV. Provider business mailing address

200 E COURT ST STE 710
KANKAKEE IL
60901-3845
US

V. Phone/Fax

Practice location:
  • Phone: 815-408-1262
  • Fax:
Mailing address:
  • Phone: 815-408-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRACY R MCKENNEY
Title or Position: MANAGER
Credential: LCPC
Phone: 815-408-1262