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General NPI Number Information
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NPI Number | 1649939695
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Entity Type | Individual
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Provider Name | MARY KELLY KIRK-WILLENBRING MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1915 LYNDALE AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3104
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Country | US
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Telephone | 800-336-5973
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Fax | 612-234-4689
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Provider Business Mailing Address
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Address Line | 1915 JULIET AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1710
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Country | US
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Telephone | 612-860-7566
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC03021
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License Number State | MN
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