Jonathon Matthew Keck, LPC, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180015714 Issued in IL

Practice address

102 W Kenwood Ave Ste 120a
Decatur, IL 62526-4368

Phone

(217) 693-6072

NPI assigned

Jan 21, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Community Health Improvement Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1831635770

  Corporate Officer

  CMS ownership

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.

• Edgewood Clinical Services, P.C.

  • Psychologist
  • Naperville, IL
  • NPI 1295914646

  Mental Health

  Medicare reassignment NPD
• Psychology Specialists LTD

  • Clinical Psychologist
  • Bloomington, IL
  • NPI 1053368605
  NPD (past)
• Psychology Specialists LTD

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1003473448
  NPD (past)

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1275285140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 N OAKCREST CT",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263446",
            "telephone_number": "217-412-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W KENWOOD AVE STE 120A",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264368",
            "telephone_number": "217-693-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KECK",
        "first_name": "JONATHON",
        "middle_name": "MATTHEW",
        "credential": "LPC, LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-21",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.016620",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180015714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
            "identifier": "180015714",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
            "identifier": "178.016620",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marla G Karraker, PA-C
• Mikaela Kasperek, PHD, RD
• Komal Kaul, M.D.
• Jasleen Kaur, MD
• Jasmine M Kaylor
• John Chris Kefalas, M.D.
• Melissa L Kehart
• Cameron J Kell, MD
• Kristina Keller, RBT
• Kelly Clark DDS PC

• Professional Counselor in Decatur, IL
• Providers in Decatur, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.