Katheleen Avila, M.A. LIC PSYCHOLOGIS

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP0449 Issued in MN

Practice address

3608 44TH Ave S
Kavila@Integrativemindfulness.Com
Minneapolis, MN 55406-2906

Phone

(612) 872-9231

Fax

(612) 722-3306

NPI assigned

Feb 15, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Mindfulness LLC

  • Counseling Psychologist
  • Minneapolis, MN
  • NPI 1457630634
  NPD (past) Authorized official

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1255305306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 44TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062906",
            "telephone_number": "612-872-9231",
            "fax_number": "612-722-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 44TH AVE S",
            "address_2": "KAVILA@INTEGRATIVEMINDFULNESS.COM",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062906",
            "telephone_number": "612-872-9231",
            "fax_number": "612-722-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILA",
        "first_name": "KATHELEEN",
        "credential": "M.A. LIC PSYCHOLOGIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP0449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045248300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Dodds Avery, CNM PHD
• Aviation ABA Therapy MN LLC
• Avid Behavior Health Services
• Yuval Avidan, MD
• Enrique J Avila III, MD
• Emily Aviles, ACNP
• Cheryl R. Avina, M.ED.
• Aviv Health Care, Inc.
• Aviva Therapy & Healing
• Avivo

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.