Provider Demographics
NPI:1396265799
Name:KINDRED, JOSEPH MARINER (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARINER
Last Name:KINDRED
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:OSTAVIOLOUIS SURANO
Other - Last Name:DHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:E2498 350TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-6212
Mailing Address - Country:US
Mailing Address - Phone:262-726-1688
Mailing Address - Fax:207-708-5352
Practice Address - Street 1:E2498 350TH AVE.
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-6212
Practice Address - Country:US
Practice Address - Phone:262-726-1688
Practice Address - Fax:207-708-5352
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI571-228106H00000X
WI1233-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100093715Medicaid
WI100093715Medicaid