Provider Demographics
NPI:1760558993
Name:KULSETH, MARJORIE ANNE (ATR-BC, LPCC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:KULSETH
Suffix:
Gender:F
Credentials:ATR-BC, LPCC
Other - Prefix:
Other - First Name:JORIE
Other - Middle Name:
Other - Last Name:KULSETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATR-BC, LPCC
Mailing Address - Street 1:177 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1919
Mailing Address - Country:US
Mailing Address - Phone:651-329-1869
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN00692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health