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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