Provider Demographics
NPI:1558083212
Name:MANAHAN, KAY LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LYNN
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W TRAVELERS TRL
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2553
Mailing Address - Country:US
Mailing Address - Phone:952-894-7722
Mailing Address - Fax:952-894-0882
Practice Address - Street 1:4555 ERIN DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3432
Practice Address - Country:US
Practice Address - Phone:952-894-7722
Practice Address - Fax:952-894-0882
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist