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General NPI Number Information
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NPI Number | 1831901289
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Entity Type | Individual
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Provider Name | CASSIDY KUNERTH MS, LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 702 34TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2962
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Country | US
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Telephone | 320-762-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 809 ELM ST
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5296
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Country | US
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Telephone | 320-762-3057
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC04732
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License Number State | MN
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