Provider Demographics
NPI:1801353149
Name:WELZ-SCHULZETENBERG, KAYLA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:WELZ-SCHULZETENBERG
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-9560
Mailing Address - Country:US
Mailing Address - Phone:320-249-0113
Mailing Address - Fax:
Practice Address - Street 1:166 19TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2155
Practice Address - Country:US
Practice Address - Phone:320-656-7047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
MNCC01219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional