Healthcare Provider Details

I. General information

NPI: 1679566368
Provider Name (Legal Business Name): KATHLEEN KAY TOBEY LP LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN KAY DAVIS

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 1/2 N LAKE AVE RM 201
DULUTH MN
55802-2018
US

IV. Provider business mailing address

17 1/2 N LAKE AVE RM 201
DULUTH MN
55802-2018
US

V. Phone/Fax

Practice location:
  • Phone: 218-740-4389
  • Fax: 218-740-4389
Mailing address:
  • Phone: 218-740-4389
  • Fax: 218-740-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number772
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1757
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: