Provider Demographics
NPI:1518425230
Name:KC COUNSELING, LLC
Entity Type:Organization
Organization Name:KC COUNSELING, LLC
Other - Org Name:KAITLYN CORNELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-377-0299
Mailing Address - Street 1:1104 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3245
Mailing Address - Country:US
Mailing Address - Phone:217-621-0766
Mailing Address - Fax:
Practice Address - Street 1:206 N RANDOLPH ST STE 508
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3949
Practice Address - Country:US
Practice Address - Phone:217-377-0299
Practice Address - Fax:855-750-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty