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NPI Code Detail

MEDICARE: KIM ALTSTAETTER LPCCS

MEDICARE: KIM ALTSTAETTER LPCCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorE.0500038-SUPVOH

General Provider Information

NPI Number : 1598939290
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM ALTSTAETTER LPCCS
Provider Business Mailing Address
First Line : 4761 STATE ROUTE 29
Second Line :
City : CELINA
State : OH
Zip : 45822-8216
Country : US
Telephone Number : 419-584-1000
Fax Number : 419-584-1825
Provider Business Practice Location Address
First Line : 4761 STATE ROUTE 29
Second Line :
City : CELINA
State : OH
Zip : 45822-8216
Country : US
Telephone Number : 419-584-1000
Fax Number : 419-584-1825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2008
Last Update Date : 04/15/2008

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Directions to “ KIM ALTSTAETTER LPCCS” Practice Location

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