Healthcare Provider Details

I. General information

NPI: 1780505669
Provider Name (Legal Business Name): KATE LAUREN MCKINNEY BS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6050
FARGO ND
58108-6050
US

IV. Provider business mailing address

8046 CHEYENNE AVE
CHANHASSEN MN
55317-9783
US

V. Phone/Fax

Practice location:
  • Phone: 701-231-7671
  • Fax:
Mailing address:
  • Phone: 952-463-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: