Provider Demographics
NPI:1255657904
Name:FINNERTY, KELLY O (LAMFT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:O
Last Name:FINNERTY
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 CROCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5011
Mailing Address - Country:US
Mailing Address - Phone:952-926-3376
Mailing Address - Fax:
Practice Address - Street 1:4826 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1001
Practice Address - Country:US
Practice Address - Phone:612-387-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist