Provider Demographics
NPI:1417424185
Name:CIAPETTA, KELLY (LPCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CIAPETTA
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 BANNING AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3206
Mailing Address - Country:US
Mailing Address - Phone:330-495-2736
Mailing Address - Fax:
Practice Address - Street 1:4756 BANNING AVE STE 215
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3206
Practice Address - Country:US
Practice Address - Phone:330-495-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001696101YM0800X
MNCC01696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty