Healthcare Provider Details

I. General information

NPI: 1558717371
Provider Name (Legal Business Name): MICHELLE KIMMAN MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LENTZ

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 5TH AVE SE
LITTLE FALLS MN
56345-3317
US

IV. Provider business mailing address

520 NW 5TH ST
BRAINERD MN
56401-2902
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-6647
  • Fax: 320-632-9525
Mailing address:
  • Phone: 218-829-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2910
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: