=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649192659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN ELLIOTT COUNSELING, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 8TH ST.
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-398-9066
-----------------------------------------------------
Fax | 217-398-9077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 8TH ST.
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-398-9066
-----------------------------------------------------
Fax | 217-398-9077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING LEAD
-----------------------------------------------------
Name | TAREVA SCHWANKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-398-9066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------