Provider Demographics
NPI:1346427523
Name:KUETTNER, ELIZABETH E (MC, LPC, CPRP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:KUETTNER
Suffix:
Gender:F
Credentials:MC, LPC, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 W BROADWAY AVE STE 112A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3577
Mailing Address - Country:US
Mailing Address - Phone:612-752-8320
Mailing Address - Fax:612-752-8301
Practice Address - Street 1:5510 W BROADWAY AVE STE 112A
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3577
Practice Address - Country:US
Practice Address - Phone:612-752-8320
Practice Address - Fax:612-752-8301
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health