Provider Demographics
NPI:1982996625
Name:BEHRENS, KATHLEEN (LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 6TH ST E
Mailing Address - Street 2:#300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1654
Mailing Address - Country:US
Mailing Address - Phone:651-221-0334
Mailing Address - Fax:651-221-4449
Practice Address - Street 1:287 6TH ST E
Practice Address - Street 2:#300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1654
Practice Address - Country:US
Practice Address - Phone:651-221-0334
Practice Address - Fax:651-221-4449
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303069101YA0400X
MN12671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical