Provider Demographics
NPI:1952182172
Name:CARNELIA MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:CARNELIA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTLESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-294-6112
Mailing Address - Street 1:7300 147TH ST W STE 215
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7541
Mailing Address - Country:US
Mailing Address - Phone:651-294-6112
Mailing Address - Fax:651-294-6715
Practice Address - Street 1:7300 147TH ST W STE 215
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7541
Practice Address - Country:US
Practice Address - Phone:651-294-6112
Practice Address - Fax:651-294-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center