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General NPI Number Information
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NPI Number | 1114074028
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Entity Type | Individual
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Provider Name | MELISSA ANN BOLLINGER-KINNEY M.S.ED LPC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 3021 HARBOR LN N STE 206
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City | PLYMOUTH
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State | MN
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Zip | 55447-5120
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Country | US
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Telephone | 763-559-1640
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Fax | 763-559-1617
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Provider Business Mailing Address
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Address Line | 6369 POLARIS LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-3938
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Country | US
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Telephone | 612-508-7115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 226
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License Number State | MN
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