Provider Demographics
NPI:1386923340
Name:EL KOURY, KATHLEEN ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:EL KOURY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3362 BIG PINE TRL STE A
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1409
Mailing Address - Country:US
Mailing Address - Phone:217-383-0151
Mailing Address - Fax:217-633-4555
Practice Address - Street 1:3362 BIG PINE TRL STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1409
Practice Address - Country:US
Practice Address - Phone:217-383-0151
Practice Address - Fax:217-633-4555
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490148371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical