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NPI Code Detail

MEDICARE: KAILA PARK LPCC

MEDICARE: KAILA PARK LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor01887MN

General Provider Information

NPI Number : 1114431558
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILA PARK LPCC
Provider Business Mailing Address
First Line : 2715 LONGACRES DR
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317-7557
Country : US
Telephone Number : 763-458-5756
Fax Number :
Provider Business Practice Location Address
First Line : 3033 EXCELSIOR BLVD STE 215
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-5274
Country : US
Telephone Number : 651-456-8396
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 10/30/2025

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Directions to “ KAILA PARK LPCC” Practice Location

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