Healthcare Provider Details

I. General information

NPI: 1952182172
Provider Name (Legal Business Name): CARNELIA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 147TH ST W STE 404
APPLE VALLEY MN
55124-7580
US

IV. Provider business mailing address

7300 147TH ST W STE 404
APPLE VALLEY MN
55124-7580
US

V. Phone/Fax

Practice location:
  • Phone: 651-294-6112
  • Fax: 651-294-6715
Mailing address:
  • Phone: 651-294-6112
  • Fax: 651-294-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH KITTLESON
Title or Position: OWNER
Credential:
Phone: 651-294-6112