Provider Demographics
NPI:1922326412
Name:KVEENE, KELLY MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:KVEENE
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:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-0284
Mailing Address - Country:US
Mailing Address - Phone:320-905-4206
Mailing Address - Fax:320-200-7480
Practice Address - Street 1:217 INDUSTRIAL DR SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2989
Practice Address - Country:US
Practice Address - Phone:320-905-4206
Practice Address - Fax:320-200-7480
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN1715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health