Provider Demographics
NPI:1326896010
Name:LORI KINSTAD PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:LORI KINSTAD PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-655-5214
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2916
Mailing Address - Country:US
Mailing Address - Phone:612-655-5214
Mailing Address - Fax:612-500-4847
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2916
Practice Address - Country:US
Practice Address - Phone:612-655-5214
Practice Address - Fax:612-500-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health