Healthcare Provider Details

I. General information

NPI: 1811107766
Provider Name (Legal Business Name): KRISTI LYNN BROWN M. A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 94TH AVE N
BROOKLYN PARK MN
55443-1992
US

IV. Provider business mailing address

9400 ZANE AVE N
BROOKLYN PARK MN
55443-1814
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-6800
  • Fax: 763-315-6685
Mailing address:
  • Phone: 763-762-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1385
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: