Healthcare Provider Details

I. General information

NPI: 1255243317
Provider Name (Legal Business Name): BRYN HENNESSY MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4749 CHICAGO AVE STE 2B
MINNEAPOLIS MN
55407-4181
US

IV. Provider business mailing address

4749 CHICAGO AVE STE 2B
MINNEAPOLIS MN
55407-4181
US

V. Phone/Fax

Practice location:
  • Phone: 612-460-8816
  • Fax: 888-655-4514
Mailing address:
  • Phone: 612-460-8816
  • Fax: 888-655-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03365
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: