Organization
BEHAVIORAL WELLNESS COUNSELING CLINIC, LLC
Active
Other names
Behavioral Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY LEE KLING KOTVAL MA. LPCC (DIRECTOR)
(952) 440-3100
Entity
Organization
Contact information
Practice address
14093 COMMERCE AVE NE, PRIOR LAKE, MN 55372-1495
(952) 440-3100
(952) 440-3100
Mailing address
14093 COMMERCE AVE NE, PRIOR LAKE, MN 55372-1495
(952) 440-3100
(952) 440-3100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPCC
MN
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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