=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982996625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN BEHRENS L.I.C.S.W., L.A.D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2011
-----------------------------------------------------
Last Update Date | 05/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 287 6TH ST E #300
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55101-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-221-0334
-----------------------------------------------------
Fax | 651-221-4449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 287 6TH ST E #300
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55101-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-221-0334
-----------------------------------------------------
Fax | 651-221-4449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 303069
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1267
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------