Healthcare Provider Details

I. General information

NPI: 1346508009
Provider Name (Legal Business Name): MARINDA S KIMMEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINDA S REID LMFT

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date: 04/11/2018
Reactivation Date: 07/18/2018

III. Provider practice location address

8085 WAYZATA BLVD STE 203
ST LOUIS PARK MN
55426-1461
US

IV. Provider business mailing address

8085 WAYZATA BLVD STE 203
ST LOUIS PARK MN
55426-1461
US

V. Phone/Fax

Practice location:
  • Phone: 612-296-3800
  • Fax: 612-259-7665
Mailing address:
  • Phone: 612-296-3800
  • Fax: 612-259-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2348
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: