=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477567949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LUTHER KASTEN JR. LCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1195 OHIO ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-947-6576
-----------------------------------------------------
Fax | 207-947-6576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1195 OHIO ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-745-8790
-----------------------------------------------------
Fax | 207-942-9877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | CC57
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------