Provider Demographics
NPI:1114074028
Name:BOLLINGER-KINNEY, MELISSA ANN (MSED LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:BOLLINGER-KINNEY
Suffix:
Gender:F
Credentials:MSED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6369 POLARIS LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3938
Mailing Address - Country:US
Mailing Address - Phone:612-508-7115
Mailing Address - Fax:
Practice Address - Street 1:3021 HARBOR LN N STE 206
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5120
Practice Address - Country:US
Practice Address - Phone:763-559-1640
Practice Address - Fax:763-559-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
MN226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty