Provider Demographics
NPI:1720623978
Name:KJERSTINE MAAS COUNSELING, LLC
Entity type:Organization
Organization Name:KJERSTINE MAAS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KJERSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:309-242-2884
Mailing Address - Street 1:509 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3147
Mailing Address - Country:US
Mailing Address - Phone:309-242-2884
Mailing Address - Fax:
Practice Address - Street 1:1224 TOWANDA AVE STE 22
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7414
Practice Address - Country:US
Practice Address - Phone:309-242-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)