Provider Demographics
NPI:1114431558
Name:PARK, KAILA JOYCE (LPCC)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:JOYCE
Last Name:PARK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 LONGACRES DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-7557
Mailing Address - Country:US
Mailing Address - Phone:763-458-5756
Mailing Address - Fax:
Practice Address - Street 1:3033 EXCELSIOR BLVD STE 215
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-5274
Practice Address - Country:US
Practice Address - Phone:651-456-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional