Provider Demographics
NPI:1942306964
Name:KITTILSON, BRENDA L (MS LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:KITTILSON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:SUITE 101 BHSI LLC
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:7616 CURRELL BLVD
Practice Address - Street 2:SUITE 290 BHSI LLC
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8204
Practice Address - Country:US
Practice Address - Phone:651-769-6550
Practice Address - Fax:651-769-6599
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00159101YM0800X
MN130331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical