Healthcare Provider Details

I. General information

NPI: 1629720818
Provider Name (Legal Business Name): KINSHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 BRYANT AVE S
MINNEAPOLIS MN
55408-3607
US

IV. Provider business mailing address

3252 BRYANT AVE S
MINNEAPOLIS MN
55408-3607
US

V. Phone/Fax

Practice location:
  • Phone: 612-483-5726
  • Fax:
Mailing address:
  • Phone: 612-483-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BETTINA STUECHER
Title or Position: CLINIC OWNER
Credential:
Phone: 651-235-6483