Provider Demographics
NPI:1275285140
Name:KECK, JONATHON MATTHEW (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:MATTHEW
Last Name:KECK
Suffix:
Gender:M
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N OAKCREST CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3446
Mailing Address - Country:US
Mailing Address - Phone:217-412-5543
Mailing Address - Fax:
Practice Address - Street 1:102 W KENWOOD AVE STE 120A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4368
Practice Address - Country:US
Practice Address - Phone:217-693-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016620101YM0800X
IL180015714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180015714OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL178.016620OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION