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NPI Code Detail

MEDICARE: KELLY ANN SENESAC MA, LMFT

MEDICARE: KELLY ANN SENESAC MA, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1679MN

General Provider Information

NPI Number : 1508072604
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANN SENESAC MA, LMFT
Provider Business Mailing Address
First Line : 9400 ZANE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1814
Country : US
Telephone Number : 763-772-8800
Fax Number : 763-315-4669
Provider Business Practice Location Address
First Line : 111 HUNDERTMARK RD STE 205N
Second Line :
City : CHASKA
State : MN
Zip : 55318-1586
Country : US
Telephone Number : 952-903-1350
Fax Number : 952-426-3856
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 11/10/2020

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Directions to “ KELLY ANN SENESAC MA, LMFT” Practice Location

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