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General NPI Number Information
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NPI Number | 1871877621
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Entity Type | Organization
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Legal Business Name | KEVIN ELLIOTT COUNSELING, PC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2001 PHILO RD
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City | URBANA
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State | IL
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Zip | 61802-8007
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Country | US
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Telephone | 217-398-9066
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Fax | 217-398-9077
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Provider Business Mailing Address
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Address Line | 2001 PHILO RD
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City | URBANA
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State | IL
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Zip | 61802-8007
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Country | US
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Telephone | 217-398-9066
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Fax | 217-398-9077
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MELANIE I HOOGSTRAAT
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Credential |
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Telephone | 217-552-1211
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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 | 149014837
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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