Individual provider Active NPI

Kristin L Maxwell, PHD, CRC, LCPC

  • Professional Counselor
  • Champaign, IL
National Provider Identifier
1164134284
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180017061 Issued in IL
Practice address
1802 S Mattis Ave
Champaign, IL 61821-5923
Phone
(217) 365-2855
Fax
(217) 383-3439
NPI assigned
Dec 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180017061 IL Primary

Addresses

Primary practice location

1802 S Mattis Ave
Champaign, IL 61821-5923

Mailing address

611 W Park St
Fapc
Urbana, IL 61801-2501
Phone (217) 383-3311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250620002681 IL Practitioner - Mental Health Counselor 0749792232 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1802 S Mattis Ave
Champaign, IL 61821-5923
Phone (217) 326-1330

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jun 13, 2025 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jun 13, 2025 Accepting new patients
Carle Health Care Incorporated CurrentSince Jun 13, 2025 Accepting new patients

Locations

1802 S Mattis Ave
Champaign, IL 61821
Phone (217) 365-2855

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1164134284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501",
            "telephone_number": "217-383-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 S MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215923",
            "telephone_number": "217-365-2855",
            "fax_number": "217-383-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "KRISTIN",
        "middle_name": "L",
        "credential": "PHD, CRC, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-20",
        "last_updated": "2025-07-02",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180017061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.