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General NPI Number Information
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NPI Number | 1720623978
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Entity Type | Organization
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Legal Business Name | KJERSTINE MAAS COUNSELING, LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 1224 TOWANDA AVE STE 22
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City | BLOOMINGTON
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State | IL
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Zip | 61701-7414
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Country | US
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Telephone | 309-242-2884
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Fax |
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Provider Business Mailing Address
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Address Line | 509 E WALNUT ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-3147
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Country | US
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Telephone | 309-242-2884
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KJERSTINE MAAS
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Credential | MS, LCPC
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Telephone | 309-242-2884
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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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