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NPI Code Detail

MEDICARE: KATHLEEN BACKUS MA, LCPC

MEDICARE: KATHLEEN BACKUS MA, LCPC
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
1101YP2500XProfessional Counselor180004305IL
2101YM0800XMental Health Counselor180004305IL

General Provider Information

NPI Number : 1871782805
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN BACKUS MA, LCPC
Provider Business Mailing Address
First Line : 2203 E WASHINGTON ST
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61701-4322
Country : US
Telephone Number : 309-663-0781
Fax Number :
Provider Business Practice Location Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 309-212-6007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2007
Last Update Date : 01/23/2025

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Directions to “ KATHLEEN BACKUS MA, LCPC” Practice Location

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