Provider Demographics
NPI:1356014161
Name:HERLING, KATHLEEN ALIDA (MS, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALIDA
Last Name:HERLING
Suffix:
Gender:F
Credentials:MS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 6TH ST NE # 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-4583
Mailing Address - Country:US
Mailing Address - Phone:608-406-0193
Mailing Address - Fax:
Practice Address - Street 1:819 2ND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2808
Practice Address - Country:US
Practice Address - Phone:612-204-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306041101YA0400X
09351225A00000X
MNCC02881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist