Individual
KYLE JOHANNESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
(612) 767-7222
Mailing address
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5845
(612) 767-7222
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC02342
MN
Other
Enumeration date
02/11/2020
Last updated
09/05/2024
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