Healthcare Provider Details

I. General information

NPI: 1366759953
Provider Name (Legal Business Name): KELLI D TAYLOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI PRICE MHPP

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 6TH STREET FRONTAGE RD E STE 2100
SPRINGFIELD IL
62703-5758
US

IV. Provider business mailing address

5220 6TH STREET FRONTAGE RD E STE 2100
SPRINGFIELD IL
62703-5758
US

V. Phone/Fax

Practice location:
  • Phone: 217-585-5197
  • Fax: 217-670-1860
Mailing address:
  • Phone: 217-585-5197
  • Fax: 217-670-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.032768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: