Provider Demographics
NPI:1356618664
Name:KINSELLA, MAREA BRANCH (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MAREA
Middle Name:BRANCH
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MAREA
Other - Middle Name:
Other - Last Name:KIENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 OLEARY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2340
Mailing Address - Country:US
Mailing Address - Phone:651-365-8296
Mailing Address - Fax:651-454-3492
Practice Address - Street 1:3450 OLEARY LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2340
Practice Address - Country:US
Practice Address - Phone:651-365-8296
Practice Address - Fax:651-454-3492
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist