Healthcare Provider Details

I. General information

NPI: 1093183923
Provider Name (Legal Business Name): KAULA MARIE RYKS MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER LAKE ROAD NW SUITE 110
NEW BRIGHTON MN
55112
US

IV. Provider business mailing address

11010 PRAIRIE LAKES DR
EDEN PRAIRIE MN
55344-3884
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-1718
  • Fax: 651-379-1738
Mailing address:
  • Phone: 952-746-2522
  • Fax: 952-746-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number01052
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: