Healthcare Provider Details

I. General information

NPI: 1548182165
Provider Name (Legal Business Name): CRIVELLO CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 WACOUTA ST STE 240
SAINT PAUL MN
55101-1650
US

IV. Provider business mailing address

413 WACOUTA ST STE 240
SAINT PAUL MN
55101-1650
US

V. Phone/Fax

Practice location:
  • Phone: 651-413-3618
  • Fax: 651-317-7043
Mailing address:
  • Phone: 651-413-3618
  • Fax: 651-317-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA EDITH SCHRUNK CRIVELLO
Title or Position: OWNER, THERAPIST
Credential: LICSW
Phone: 715-563-2469