NPIMap

Organization Active NPI

Optum Behavioral Care Therapy Services of Illinois PC

Doing business as KP Counseling of Illinois

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1235949553
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
OPTUM BEHAVIORAL CARE THERAPY SERVICES OF ILLINOIS PC
Doing business as
KP Counseling of Illinois
Practice address
6392 Linden Rd
Rockford, IL 61109-2816
Phone
(779) 368-0060
Fax
(779) 368-0579
NPI assigned
Jan 9, 2025
Last updated
Mar 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Authorized official

Name
Stacy Cloyd
Title
Secretary
Phone
(763) 330-4953

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

6392 Linden Rd
Rockford, IL 61109-2816

Mailing address

6392 Linden Rd
Rockford, IL 61109-2816
Phone (779) 368-0060

Other practice location 1

4753 N Broadway St Ste 403
Chicago, IL 60640-7910
Phone (779) 368-0060

Other practice location 2

695 N Perryville Rd Ste 4
Rockford, IL 61107-6225
Phone (779) 368-0060

Other practice location 3

820 Davis St Ste 222
Evanston, IL 60201-4445
Phone (779) 368-0060

Other practice location 4

12151 Regency Pkwy Ste 12189
Huntley, IL 60142-7644
Phone (779) 368-0060

Other names 1

  • KP Counseling of Illinois Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250319003644 IL Part B Supplier - Clinic/Group Practice 2163944190 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Chicago, IL; Evanston, IL; Rockford, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Optum Behavioral Care Therapy Services of Illinois PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4753 N Broadway St
Ste 403
Chicago, IL 60640
Phone (773) 989-2780

12151 Regency Pkwy
Ste 12189
Huntley, IL 60142
Phone (779) 368-0660

695 N Perryville Rd
Ste 4
Rockford, IL 61107
Phone (815) 227-9900

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1736380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1235949553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4753 N Broadway St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606407910",
            "country_code": "US",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "695 N Perryville Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611076225",
            "country_code": "US",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 Davis St Ste 222",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602014445",
            "country_code": "US",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12151 Regency Pkwy Ste 12189",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601427644",
            "country_code": "US",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTUM BEHAVIORAL CARE THERAPY SERVICES OF ILLINOIS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-09",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "CLOYD",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "763-330-4953"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KP Counseling of Illinois",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KP Counseling of Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.