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Organization
KESMA FLAME LILY LLC
Active
Organization
KESMA FLAME LILY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETRONELLAH THOKO BENSEN LPCC (CEO/CLINICAL DIRECTOR)
(612) 408-7733
Entity
Organization
Contact information
Practice address
7030 BROOKLYN BLVD STE 2047, BROOKLYN CENTER, MN 55429-1370
(612) 408-7733
(763) 292-5653
Mailing address
20705 OTERO AVE, HASTINGS, MN 55033-9600
(612) 408-7733
(763) 292-5653
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1000X
Migrant Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
BEHAVIORAL HEALTH
MN
05
—
6744924000
—
MN
Enumeration date
07/22/2018
Last updated
09/06/2025
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