Provider Demographics
NPI:1114350311
Name:KASTEN, CARLIE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:MICHELLE
Last Name:KASTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:MICHELLE
Other - Last Name:PIETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 W ALTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1441
Mailing Address - Country:US
Mailing Address - Phone:618-972-2648
Mailing Address - Fax:
Practice Address - Street 1:904 M L KING DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3058
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor