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General NPI Number Information
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NPI Number | 1689541195
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE THERAPY LLC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 2919 CROSSING CT STE 8
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City | CHAMPAIGN
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State | IL
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Zip | 61822-5904
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Country | US
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Telephone | 217-275-8811
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Fax | 217-600-3205
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Provider Business Mailing Address
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Address Line | 2919 CROSSING CT STE 8
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City | CHAMPAIGN
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State | IL
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Zip | 61822-5904
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Country | US
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Telephone | 217-275-8811
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Fax | 217-600-3205
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN EL KOURY
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Credential | LCSW
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Telephone | 217-275-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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