Healthcare Provider Details

I. General information

NPI: 1558976209
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W PIONEER PKWY STE 14
PEORIA IL
61615-1882
US

IV. Provider business mailing address

2000 W PIONEER PKWY STE 14
PEORIA IL
61615-1882
US

V. Phone/Fax

Practice location:
  • Phone: 309-550-1001
  • Fax:
Mailing address:
  • Phone: 309-550-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATIE NEIDETCHER
Title or Position: OWNER
Credential: LCPC
Phone: 309-550-1001