Healthcare Provider Details

I. General information

NPI: 1124919212
Provider Name (Legal Business Name): AMANDA MARIE CARSTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E MAIN ST
BENTON IL
62812-2154
US

IV. Provider business mailing address

1009 ELECTION CIR
BENTON IL
62812-1008
US

V. Phone/Fax

Practice location:
  • Phone: 618-603-3033
  • Fax:
Mailing address:
  • Phone: 618-513-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: