Provider Demographics
NPI:1992239370
Name:KALTENECKER, THOMAS CHRISTIAN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHRISTIAN
Last Name:KALTENECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STANTON CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6245
Mailing Address - Country:US
Mailing Address - Phone:847-769-6147
Mailing Address - Fax:
Practice Address - Street 1:6 STANTON CT
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6245
Practice Address - Country:US
Practice Address - Phone:847-769-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL684717101YA0400X
IL178012185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)