Provider Demographics
NPI:1467015057
Name:ALTHOFF, CARRIE J
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:J
Last Name:ALTHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 4TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4188
Mailing Address - Country:US
Mailing Address - Phone:217-347-5880
Mailing Address - Fax:217-347-5897
Practice Address - Street 1:1901 S 4TH ST STE 213
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4188
Practice Address - Country:US
Practice Address - Phone:217-347-5880
Practice Address - Fax:217-347-5897
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health