Provider Demographics
NPI:1689821951
Name:MINSSEN, KELLY ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:MINSSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CAPRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP
Mailing Address - Street 1:25000 HACKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7950
Mailing Address - Country:US
Mailing Address - Phone:402-350-9754
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:SUITE 270
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9078
Practice Address - Country:US
Practice Address - Phone:712-256-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8161101YM0800X
IA001585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health