| Christina Kittstein Llc | |
|
6209 E Main St Maryville IL 62062-2015 | |
| (618) 979-7301 | |
| (888) 972-8757 |
| Full Name | Christina Kittstein Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6209 E Main St, Maryville, Illinois |
| Authorized Official Name and Position | Christina Kittstein (MANAGER) |
| Authorized Official Contact | 6189797301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christina Kittstein Llc 10104 State Route 4 Lebanon IL 62254-2612 Ph: (618) 979-7301 | Christina Kittstein Llc 6209 E Main St Maryville IL 62062-2015 Ph: (618) 979-7301 |
| NPI Number | 1427670819 |
|---|---|
| Provider Enumeration Date | 05/08/2020 |
| Last Update Date | 05/08/2020 |
| Certification Date | 05/08/2020 |
| Medicare PECOS PAC ID | 1153762554 |
|---|---|
| Medicare Enrollment ID | O20240516001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427670819 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Christina M Kittstein |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518073683 PECOS PAC ID: 2062853468 Enrollment ID: I20240516001784 |
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