Provider Demographics
NPI:1770289761
Name:KRITZECK, CAILA BLAKE (MA, LPCC, ATR-P)
Entity type:Individual
Prefix:
First Name:CAILA
Middle Name:BLAKE
Last Name:KRITZECK
Suffix:
Gender:F
Credentials:MA, LPCC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 HIGHWAY 55 STE 300
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6389
Mailing Address - Country:US
Mailing Address - Phone:763-412-0722
Mailing Address - Fax:
Practice Address - Street 1:10000 HIGHWAY 55 STE 300
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6389
Practice Address - Country:US
Practice Address - Phone:763-412-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional