Healthcare Provider Details

I. General information

NPI: 1871877621
Provider Name (Legal Business Name): KEVIN ELLIOTT COUNSELING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PHILO RD
URBANA IL
61802-8007
US

IV. Provider business mailing address

2001 PHILO RD
URBANA IL
61802-8007
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014837
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MELANIE I HOOGSTRAAT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 217-552-1211