Provider Demographics
NPI:1699021923
Name:KIM, AMY RUTH (LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:KIM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7438 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4136
Mailing Address - Country:US
Mailing Address - Phone:763-250-8385
Mailing Address - Fax:
Practice Address - Street 1:7438 BLAISDELL AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4136
Practice Address - Country:US
Practice Address - Phone:763-250-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1145101YP2500X, 251S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program