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General NPI Number Information
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NPI Number | 1447003256
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Entity Type | Organization
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Legal Business Name | TINA KAMPWERTH COUNSELING INC
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 502 W MAIN ST STE 300
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City | COLLINSVILLE
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State | IL
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Zip | 62234-3055
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Country | US
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Telephone | 618-795-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 8031 JOSEPH CT
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City | SAINT ROSE
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State | IL
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Zip | 62230-2506
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Country | US
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Telephone | 618-795-0630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TINA MARIE KAMPWERTH
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Credential | LCPC
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Telephone | 618-795-0630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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