Healthcare Provider Details

I. General information

NPI: 1669711966
Provider Name (Legal Business Name): STACY MARIE KIEL-VANCURA MS LPCC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16204 HIGHWAY 7
MINNETONKA MN
55345-3405
US

IV. Provider business mailing address

16204 MN-7
MINNETONKA MN
55345
US

V. Phone/Fax

Practice location:
  • Phone: 763-267-1108
  • Fax:
Mailing address:
  • Phone: 763-267-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00527
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: