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General NPI Number Information
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NPI Number | 1427670819
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Entity Type | Organization
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Legal Business Name | CHRISTINA KITTSTEIN LLC
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 6209 E MAIN ST
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City | MARYVILLE
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State | IL
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Zip | 62062-2015
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Country | US
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Telephone | 618-979-7301
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Fax | 888-972-8757
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Provider Business Mailing Address
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Address Line | 10104 STATE ROUTE 4
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City | LEBANON
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State | IL
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Zip | 62254-2612
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Country | US
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Telephone | 618-979-7301
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Fax | 888-972-8757
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTINA KITTSTEIN
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Credential | LCPC
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Telephone | 618-979-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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