Provider Demographics
NPI:1245829720
Name:TCHIDA, KIRSTEN M (LPCC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:TCHIDA
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 1:211 HOLMES ST W STE 302
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-9905
Mailing Address - Country:US
Mailing Address - Phone:218-847-0629
Mailing Address - Fax:218-846-1285
Practice Address - Street 1:211 HOLMES ST W STE 302
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-9905
Practice Address - Country:US
Practice Address - Phone:218-847-0629
Practice Address - Fax:218-846-1285
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2717OtherMINNESOTA LICENSING BOARD