Provider Demographics
NPI:1346508009
Name:KIMMEL, MARINDA S (LMFT)
Entity Type:Individual
Prefix:
First Name:MARINDA
Middle Name:S
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARINDA
Other - Middle Name:S
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:501 N RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3450
Mailing Address - Country:US
Mailing Address - Phone:612-223-8898
Mailing Address - Fax:
Practice Address - Street 1:501 N RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3450
Practice Address - Country:US
Practice Address - Phone:612-228-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2024-02-08
Deactivation Date:2018-04-11
Deactivation Code:
Reactivation Date:2018-07-18
Provider Licenses
StateLicense IDTaxonomies
MN2348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist