MEDICARE: FULL CIRCLE COUNSELING AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1558976209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2000 W PIONEER PKWY STE 14
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1882
Country	:	US
Telephone Number	:	309-550-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 W PIONEER PKWY STE 14
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1882
Country	:	US
Telephone Number	:	309-550-1001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATIE NEIDETCHER
Credential	:	LCPC
Telephone Number	:	309-550-1001

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	05/01/2026

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