Behavioral Wellness Counseling Clinic, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPCC Issued in MN

Legal business name

BEHAVIORAL WELLNESS COUNSELING CLINIC, LLC

Doing business as

Behavioral Wellness

Practice address

14093 Commerce Ave NE
Prior Lake, MN 55372-1495

Phone

(952) 440-3100

Fax

(952) 440-3100

NPI assigned

Sep 18, 2013

Last updated

Sep 18, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Tracy Lee Kling Kotval, MA. LPCC

Title

Director

Phone

(952) 440-3100

Specialties & licenses 1

Addresses

Other names 1

• Behavioral Wellness Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1033545439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14093 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721495",
            "telephone_number": "952-440-3100",
            "fax_number": "952-440-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14093 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721495",
            "telephone_number": "952-440-3100",
            "fax_number": "952-440-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL WELLNESS COUNSELING CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-18",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "KOTVAL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LEE KLING",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "952-440-3100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA. LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "LPCC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Behavioral Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Professional Counselor in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.