Healthcare Provider Details

I. General information

NPI: 1649192659
Provider Name (Legal Business Name): KEVIN ELLIOTT COUNSELING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 8TH ST.
MATTOON IL
61938
US

IV. Provider business mailing address

105 8TH ST.
MATTOON IL
61938
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-9066
  • Fax: 217-398-9077
Mailing address:
  • Phone: 217-398-9066
  • Fax: 217-398-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAREVA SCHWANKE
Title or Position: CREDENTIALING LEAD
Credential:
Phone: 217-398-9066