Healthcare Provider Details

I. General information

NPI: 1235672973
Provider Name (Legal Business Name): AMY N KELCH-COHEN LCPC, CADC, CPT,EMDR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W CANDLETREE DR STE 101
PEORIA IL
61614-1596
US

IV. Provider business mailing address

228 E OAK PARK DR
PEORIA IL
61614-7412
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-0538
  • Fax: 309-214-0096
Mailing address:
  • Phone: 309-472-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: