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Organization

OLD TOWN COUNSELING OF NEWBURGH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KELLY KOPATICH LCSW (OWNER)
(507) 491-8887
Entity
Organization

Contact information

Practice address
4333 OLD STATE ROUTE 261, NEWBURGH, IN 47630-2652
(507) 491-8887
Mailing address
PO BOX 1114, NEWBURGH, IN 47629-1114
(507) 491-8887

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
34008915A
LICENSE
IN
Enumeration date
07/09/2021
Last updated
07/09/2021
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