Provider Demographics
NPI:1174955397
Name:COUNSELING KIDS AND ADULTS PLLC
Entity type:Organization
Organization Name:COUNSELING KIDS AND ADULTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT, LADC
Authorized Official - Phone:651-755-4276
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-0974
Mailing Address - Country:US
Mailing Address - Phone:651-755-4276
Mailing Address - Fax:888-972-5307
Practice Address - Street 1:12814 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9345
Practice Address - Country:US
Practice Address - Phone:651-755-4276
Practice Address - Fax:888-972-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302991101YA0400X
MN2626106H00000X
246ZE0500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174955397Medicaid