Basic Information
| Provider Information | |||||||||
| NPI: | 1699245001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAIL | ||||||||
| FirstName: | BAIN | ||||||||
| MiddleName: | HARRISON THOMAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 4TH AVE W STE 300 | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553791220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524968565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 4TH AVE W STE 300 | ||||||||
| Address2: | |||||||||
| City: | SHAKOPEE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553791220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524968565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 01984 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.