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Kellan Vencil
Professional Counselor in Andover, Minnesota
NPI 1083143655

Kellan Vencil is a Professional Counselor based in Andover, MN and is specialized in Professional. Kellan Vencil practices in Andover, MN. The NPI Number for Kellan Vencil is 1083143655 and holds a License No. P-1400 (Minnesota).

The current practice location address for Kellan Vencil is 1875 Station Pkwy Nw, Andover, MN and can be reached out via phone at 763-482-9598.

Location: 1875 Station Pkwy Nw, Andover, MN, 55304-3319
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1083143655
Provider Name
Kellan Vencil
Credential
Provider Entity Type
Individual
Gender
Male
Address
1875 Station Pkwy Nw, Andover, MN, 55304-3319
Phone Number
763-482-9598
Fax Number
Provider Enumeration Date
06/07/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1875 Station Pkwy Nw
City
Andover
State
Minnesota
Zip
55304-3319
Phone Number
763-482-9598
Fax Number
person
Provider Business Mailing Address Details
Address
1875 Station Pkwy Nw
City
Andover
State
Minnesota
Zip
55304-3319
Phone Number
763-482-9598
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
CC02700 (Minnesota)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
P-1400 (Nebraska)
Definition
Definition to come...
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