Healthcare Provider Details

I. General information

NPI: 1043157175
Provider Name (Legal Business Name): KAITLIN BARBEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E MARTIN LUTHER KING DR
CENTRALIA IL
62801
US

IV. Provider business mailing address

904 E MARTIN LUTHER KING DR
CENTRALIA IL
62801
US

V. Phone/Fax

Practice location:
  • Phone: 618-533-1391
  • Fax: 618-533-0012
Mailing address:
  • Phone: 618-533-1391
  • Fax: 618-533-0012

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: