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General NPI Number Information
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NPI Number | 1750476586
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Entity Type | Individual
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Provider Name | KIRSTEN LOUISE JETTINGHOFF L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 100 GRAY RD
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City | FALMOUTH
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State | ME
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Zip | 04105-2018
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Country | US
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Telephone | 207-671-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 14 PINEWOOD DR
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City | CUMBERLAND
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State | ME
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Zip | 04021-4043
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Country | US
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Telephone | 207-671-4325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC2729
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License Number State | ME
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