Individual
TINA SUE OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CADC
Contact information
Practice address
421 W MAIN ST, VANDALIA, IL 62471-2214
(618) 283-4229
Mailing address
RR 1 BOX 300C, RAMSEY, IL 62080-9402
(618) 423-9590
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17890
IL
101YM0800X
Mental Health Counselor
178.006052
IL
Other
Enumeration date
03/26/2007
Last updated
05/05/2009
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