Provider Demographics
NPI:1376415935
Name:RED LION THERAPY & CONSULTATION, LLC
Entity type:Organization
Organization Name:RED LION THERAPY & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC LADC
Authorized Official - Phone:320-245-7018
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-0026
Mailing Address - Country:US
Mailing Address - Phone:320-245-7018
Mailing Address - Fax:320-262-7076
Practice Address - Street 1:119 4TH ST STE 204
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-2209
Practice Address - Country:US
Practice Address - Phone:320-245-7018
Practice Address - Fax:320-262-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty