Provider Demographics
NPI:1861664211
Name:ANDERSON, KELSEY (MA, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 1ST ST STE B104
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1678
Mailing Address - Country:US
Mailing Address - Phone:612-868-1696
Mailing Address - Fax:763-412-1700
Practice Address - Street 1:604 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1611
Practice Address - Country:US
Practice Address - Phone:763-412-1700
Practice Address - Fax:763-324-8181
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302306101YA0400X
MNCC01560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)