Provider Demographics
NPI:1578122727
Name:KT COUNSELING LLC
Entity Type:Organization
Organization Name:KT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOFANIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-789-8351
Mailing Address - Street 1:20 GALLEON DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-3946
Mailing Address - Country:US
Mailing Address - Phone:508-789-8351
Mailing Address - Fax:
Practice Address - Street 1:634 N FALMOUTH HWY
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-3314
Practice Address - Country:US
Practice Address - Phone:508-789-8351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty