Mary Lynn Kittelson, LP, JUNGIAN ANALYST

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2078 Issued in MN

Practice address

1711 County Road B W
Suite 205-S
Roseville, MN 55113-4057

Phone

(651) 276-0305

NPI assigned

Jul 22, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1174788947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 PRIOR AVE N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551135406",
            "telephone_number": "651-489-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 COUNTY ROAD B W",
            "address_2": "SUITE 205-S",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134057",
            "telephone_number": "651-276-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KITTELSON",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "LP, JUNGIAN ANALYST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": "ZZ",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "2078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF PSYCHOANALYSIS",
            "identifier": "P911100",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN STATE TAX ID",
            "identifier": "1409168",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Roseville, MN
• Providers in Roseville, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.