Provider Demographics
NPI:1558013946
Name:MYLLYKANGAS, KATELYN EMILY (LPCC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:EMILY
Last Name:MYLLYKANGAS
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 1:33863 748TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MN
Mailing Address - Zip Code:55382-2802
Mailing Address - Country:US
Mailing Address - Phone:320-296-3539
Mailing Address - Fax:
Practice Address - Street 1:17205 YALE ST NW STE E
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-5314
Practice Address - Country:US
Practice Address - Phone:763-412-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health