Healthcare Provider Details

I. General information

NPI: 1720623978
Provider Name (Legal Business Name): KJERSTINE MAAS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 TOWANDA AVE STE 22
BLOOMINGTON IL
61701-7414
US

IV. Provider business mailing address

509 E WALNUT ST
BLOOMINGTON IL
61701-3147
US

V. Phone/Fax

Practice location:
  • Phone: 309-242-2884
  • Fax:
Mailing address:
  • Phone: 309-242-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KJERSTINE MAAS
Title or Position: THERAPIST
Credential: MS, LCPC
Phone: 309-242-2884