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NPI Code Detail

MEDICARE: KRISTIN MARIE ANTIL MA, DMIN, LPCC

MEDICARE: KRISTIN MARIE ANTIL MA, DMIN, 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
1101YM0800XMental Health Counselor02071MN

General Provider Information

NPI Number : 1306789276
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MARIE ANTIL MA, DMIN, LPCC
Provider Business Mailing Address
First Line : 851 8TH AVE NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-2704
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 320-444-1774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ KRISTIN MARIE ANTIL MA, DMIN, LPCC” Practice Location

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