Provider Demographics
NPI:1760792550
Name:ALTHOFF, KAYLA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:ALTHOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:TINSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:750 BROADWAY AVE E
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4610
Mailing Address - Country:US
Mailing Address - Phone:217-238-5701
Mailing Address - Fax:217-238-5768
Practice Address - Street 1:750 BROADWAY AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4610
Practice Address - Country:US
Practice Address - Phone:217-238-5701
Practice Address - Fax:217-238-5768
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0161531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical