Provider Demographics
NPI:1447003256
Name:TINA KAMPWERTH COUNSELING INC
Entity type:Organization
Organization Name:TINA KAMPWERTH COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KAMPWERTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-795-0630
Mailing Address - Street 1:8031 JOSEPH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-2506
Mailing Address - Country:US
Mailing Address - Phone:618-795-0630
Mailing Address - Fax:
Practice Address - Street 1:502 W MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3055
Practice Address - Country:US
Practice Address - Phone:618-795-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health