Active NPI
Kaitlin Lezcano Lytle, LMFT
- Mental Health Counselor
- St Louis Park, MN
National Provider Identifier
1881114056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 3414
- Practice address
- 3525 Monterey Dr
St Louis Park, MN 55416-5275 - Phone
- (952) 993-5990
- NPI assigned
- Jun 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3414 | MN | Primary |
Addresses
Primary practice location
3525 Monterey Dr
St Louis Park, MN 55416-5275
Mailing address
4620 York Ave S
Minneapolis, MN 55410-1866
Phone (612) 308-0246
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3414 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497916800000",
"number": "1881114056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4620 YORK AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554101866",
"telephone_number": "612-308-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 MONTEREY DR",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554165275",
"telephone_number": "952-993-5990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYTLE",
"first_name": "KAITLIN",
"middle_name": "LEZCANO",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-20",
"last_updated": "2017-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "3414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.