Provider Demographics
NPI:1295260412
Name:KALEIDOSCOPE COUNSELING
Entity type:Organization
Organization Name:KALEIDOSCOPE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD DEV. CONSULTANT AND LAMFT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-220-1642
Mailing Address - Street 1:3329 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3508
Mailing Address - Country:US
Mailing Address - Phone:612-220-1642
Mailing Address - Fax:
Practice Address - Street 1:5871 CEDAR LAKE RD S
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1472
Practice Address - Country:US
Practice Address - Phone:612-220-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3352305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service