Provider Demographics
NPI:1578014544
Name:HENNESSY, ANGELA KORI (LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KORI
Last Name:HENNESSY
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 1:3754 PLEASANT AVE # 424W
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1277
Mailing Address - Country:US
Mailing Address - Phone:651-802-8302
Mailing Address - Fax:
Practice Address - Street 1:3754 PLEASANT AVE # 424W
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1277
Practice Address - Country:US
Practice Address - Phone:651-802-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3448106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist