Individual
KELLY ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC, LPCC
Contact information
Practice address
645 3RD AVE SW, PINE CITY, MN 55063-1443
(320) 237-4227
Mailing address
645 3RD AVE SW, PINE CITY, MN 55063-1443
(320) 237-4227
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302405
MN
101YM0800X
Mental Health Counselor
Primary
1372
MN
Other
Enumeration date
05/24/2011
Last updated
12/20/2016
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