Provider Demographics
NPI:1194120519
Name:STABLE LIVING LLC
Entity type:Organization
Organization Name:STABLE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALESCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:952-240-1621
Mailing Address - Street 1:6344 RAMBLER LN
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1043
Mailing Address - Country:US
Mailing Address - Phone:952-240-1621
Mailing Address - Fax:952-472-0477
Practice Address - Street 1:6344 RAMBLER LN
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1043
Practice Address - Country:US
Practice Address - Phone:952-240-1621
Practice Address - Fax:952-472-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty