Provider Demographics
NPI:1255491114
Name:KRUMTINGER, MICHAEL LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:KRUMTINGER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MAROA
Mailing Address - State:IL
Mailing Address - Zip Code:61756-9200
Mailing Address - Country:US
Mailing Address - Phone:217-794-5973
Mailing Address - Fax:
Practice Address - Street 1:1900 E LAKE SHORE DR STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3845
Practice Address - Country:US
Practice Address - Phone:217-422-0027
Practice Address - Fax:217-422-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health