MEDICARE: NEURO ALLIES LLC

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	261QD1600X	Developmental Disabilities Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1902758071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO ALLIES LLC

Provider Business Mailing Address
First Line	:	17715 KEYSTONE AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9366
Country	:	US
Telephone Number	:	612-308-7435
Fax Number	:

Provider Business Practice Location Address
First Line	:	17715 KEYSTONE AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9366
Country	:	US
Telephone Number	:	612-308-7435
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST; OWNER
Name	:	DR. LAURIE LYNN KINCADE
Credential	:	PHD, LP, NCSP
Telephone Number	:	612-308-7435

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “NEURO ALLIES LLC ” Practice Location

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