Individual
KIRBY KACZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
2025 4TH ST STE 100, WHITE BEAR LAKE, MN 55110-2875
(651) 212-4920
Mailing address
2025 4TH ST STE 100, WHITE BEAR LAKE, MN 55110-2875
(651) 212-4920
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
4263
MN
Other
Enumeration date
01/31/2024
Last updated
01/31/2024
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