Healthcare Provider Details

I. General information

NPI: 1831553338
Provider Name (Legal Business Name): KELSEY MCLAUGHLIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6776 LAKE DR STE 170
LINO LAKES MN
55014-1201
US

IV. Provider business mailing address

6776 LAKE DR STE 170
LINO LAKES MN
55014-1201
US

V. Phone/Fax

Practice location:
  • Phone: 763-291-5505
  • Fax: 763-444-1765
Mailing address:
  • Phone: 515-202-5365
  • Fax: 763-444-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: