Provider Demographics
NPI:1376062786
Name:CIATTI, TALA MARIE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TALA
Middle Name:MARIE
Last Name:CIATTI
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 STONE CREEK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4606
Mailing Address - Country:US
Mailing Address - Phone:952-974-3999
Mailing Address - Fax:
Practice Address - Street 1:7945 STONE CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4606
Practice Address - Country:US
Practice Address - Phone:952-974-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1389OtherMN BOARD OF BEHAVIORAL HEALTH AND THERAPY LICENSE #