Provider Demographics
NPI:1063865533
Name:HENSCHEL, KASSONDRA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:
Last Name:HENSCHEL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 11TH ST N
Mailing Address - Street 2:STE 401
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 11TH ST N
Practice Address - Street 2:STE 401
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2083
Practice Address - Country:US
Practice Address - Phone:218-236-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist