Healthcare Provider Details

I. General information

NPI: 1336450469
Provider Name (Legal Business Name): KALVIN D KINSTLER MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 11TH ST S
LA CROSSE WI
54601-4116
US

IV. Provider business mailing address

PO BOX 1510
EAU CLAIRE WI
54702-1510
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-9555
  • Fax: 608-392-9432
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3790
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3790
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: