MEDICARE: KORI HENNESSY, MA, LMFT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1003319203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KORI HENNESSY, MA, LMFT PA

Provider Business Mailing Address
First Line	:	3754 PLEASANT AVE # 424W
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1277
Country	:	US
Telephone Number	:	763-342-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 E 43RD ST STE 201
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-2018
Country	:	US
Telephone Number	:	763-342-0104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KORI KORI HENNESSY
Credential	:	LMFT
Telephone Number	:	763-342-0104

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	07/17/2025

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