Kyle Justin Tam, BS

NPI #1114697422 in Mattoon, Illinois

Provider Information

NPI Number: 1114697422
Entity Type: Individual
Name: Kyle Justin Tam, BS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Credential: BS
Enumeration Date: Sep 17, 2021
Last Updated: Sep 17, 2021

Practice Location

Address: 750 BROADWAY AVE E
City: Mattoon
State: Illinois
ZIP Code: 61938-4610
Phone: (217) 238-5700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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