Provider Demographics
NPI:1356750509
Name:DUNLEAVY, KATHRYN (LPCC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:PANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14439 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8418
Mailing Address - Country:US
Mailing Address - Phone:952-334-8527
Mailing Address - Fax:
Practice Address - Street 1:245 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3467
Practice Address - Country:US
Practice Address - Phone:612-870-3787
Practice Address - Fax:612-870-3789
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional