Provider Demographics
NPI:1700419223
Name:MCKENNA COUNSELING LLC
Entity Type:Organization
Organization Name:MCKENNA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-431-1297
Mailing Address - Street 1:14107 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-9154
Mailing Address - Country:US
Mailing Address - Phone:217-377-1600
Mailing Address - Fax:
Practice Address - Street 1:3526 N CALIFORNIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1143
Practice Address - Country:US
Practice Address - Phone:309-431-1297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149013193OtherSTATE OF IL