Healthcare Provider Details

I. General information

NPI: 1376977470
Provider Name (Legal Business Name): KYLE DAVID BOSSHART LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W COLLEGE ST
DULUTH MN
55811-4906
US

IV. Provider business mailing address

714 W COLLEGE ST
DULUTH MN
55811-4906
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-0237
  • Fax:
Mailing address:
  • Phone: 218-384-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5508
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: