Provider Demographics
NPI:1609113083
Name:KB COUNSELING EVALUATION MEDIATION SERVICES
Entity Type:Organization
Organization Name:KB COUNSELING EVALUATION MEDIATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KAMISH-BUSHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-303-0534
Mailing Address - Street 1:6043 HUDSON RD
Mailing Address - Street 2:SUITE 140P
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1018
Mailing Address - Country:US
Mailing Address - Phone:651-303-0534
Mailing Address - Fax:651-337-7133
Practice Address - Street 1:6043 HUDSON RD
Practice Address - Street 2:SUITE 140P
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1018
Practice Address - Country:US
Practice Address - Phone:651-303-0534
Practice Address - Fax:651-337-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty