Provider Demographics
NPI:1245658442
Name:ZRENCHIK, KYLE (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ZRENCHIK
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12739 WOODCOURT LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8677
Mailing Address - Country:US
Mailing Address - Phone:612-355-0122
Mailing Address - Fax:612-999-1767
Practice Address - Street 1:11800 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2010
Practice Address - Country:US
Practice Address - Phone:651-271-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2688106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist