Provider Demographics
NPI:1356765473
Name:KINNEY, VICKY (LAMFT, MED)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LAMFT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 FERNMONT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHORE
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8660 FERNMONT RD
Practice Address - Street 2:
Practice Address - City:LAKE SHORE
Practice Address - State:MN
Practice Address - Zip Code:56468-2504
Practice Address - Country:US
Practice Address - Phone:218-963-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist