Provider Demographics
NPI:1942681242
Name:KAISTHA, NIKHIL (MSED, MA, LPCC)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:
Last Name:KAISTHA
Suffix:
Gender:M
Credentials:MSED, MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 WOODDALE AVE S UNIT 18
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5162
Mailing Address - Country:US
Mailing Address - Phone:612-889-2975
Mailing Address - Fax:
Practice Address - Street 1:3100 W LAKE ST STE 210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4597
Practice Address - Country:US
Practice Address - Phone:612-925-6033
Practice Address - Fax:612-925-8496
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health