Provider Demographics
NPI:1770630766
Name:KP COUNSELING LTD
Entity Type:Organization
Organization Name:KP COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER E
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-444-1730
Mailing Address - Street 1:6392 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-2816
Mailing Address - Country:US
Mailing Address - Phone:779-368-0060
Mailing Address - Fax:779-368-0579
Practice Address - Street 1:6392 LINDEN RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2816
Practice Address - Country:US
Practice Address - Phone:779-368-0060
Practice Address - Fax:815-368-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490077941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06810Medicare ID - Type Unspecified
IL209087Medicare ID - Type Unspecified
IL209087Medicare ID - Type UnspecifiedMEDICARE
ILK06813Medicare ID - Type Unspecified