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General NPI Number Information
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NPI Number | 1295212355
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Entity Type | Organization
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Legal Business Name | KESMA FLAME LILY LLC
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Dates
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Enumeration Date | 07/22/2018
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 7030 BROOKLYN BLVD STE 2047
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-1370
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Country | US
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Telephone | 612-408-7733
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Fax | 763-292-5653
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Provider Business Mailing Address
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Address Line | 20705 OTERO AVE
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City | HASTINGS
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State | MN
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Zip | 55033-9600
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Country | US
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Telephone | 612-408-7733
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Fax | 763-292-5653
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | PETRONELLAH THOKO BENSEN
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Credential | LPCC
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Telephone | 612-408-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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Taxonomy #4
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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Taxonomy #8
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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