Healthcare Provider Details

I. General information

NPI: 1154409522
Provider Name (Legal Business Name): KELLY K VOORHEES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W MAIN ST STE 106
PLAINFIELD IL
60544-2227
US

IV. Provider business mailing address

12604 S CHERRY BLOSSOM BLVD
PLAINFIELD IL
60585-2316
US

V. Phone/Fax

Practice location:
  • Phone: 815-648-8083
  • Fax:
Mailing address:
  • Phone: 630-234-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005796
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier562478620
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerTAX ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: