MEDICARE: MRS. KELLY MARIE KVEENE L.M.F.T.

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	1715	MN

General Provider Information

NPI Number	:	1922326412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY MARIE KVEENE L.M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 284
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-0284
Country	:	US
Telephone Number	:	320-905-4206
Fax Number	:	320-200-7480

Provider Business Practice Location Address
First Line	:	217 INDUSTRIAL DR SW
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-2989
Country	:	US
Telephone Number	:	320-905-4206
Fax Number	:	320-200-7480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	09/19/2019

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