Organization
TILAH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KINGSBURY LPCC (OWNER)
(612) 723-7343
Entity
Organization
Contact information
Practice address
1250 MOORE LAKE DR E STE 200-I, FRIDLEY, MN 55432-5134
(612) 568-8188
Mailing address
3954 3RD AVE S, MINNEAPOLIS, MN 55409-1609
(612) 723-7343
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/01/2024
Last updated
03/20/2025
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