Provider Demographics
NPI:1003319203
Name:KORI HENNESSY, MA, LMFT PA
Entity Type:Organization
Organization Name:KORI HENNESSY, MA, LMFT PA
Other - Org Name:RESILIENT INTIMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KORI
Authorized Official - Middle Name:KORI
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-201-7383
Mailing Address - Street 1:3754 PLEASANT AVE # 424W
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1277
Mailing Address - Country:US
Mailing Address - Phone:763-342-0104
Mailing Address - Fax:
Practice Address - Street 1:812 E 48TH ST STE 5
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1067
Practice Address - Country:US
Practice Address - Phone:651-802-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1578014544Medicaid