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General NPI Number Information
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NPI Number | 1467277723
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Entity Type | Individual
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Provider Name | KELLY MARIE SHOWALTER MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 8441 WAYZATA BLVD STE 140
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City | GOLDEN VALLEY
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State | MN
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Zip | 55426-1366
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Country | US
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Telephone | 651-769-6300
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Fax | 651-759-6349
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Provider Business Mailing Address
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Address Line | 2497 7TH AVE E STE 108
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City | NORTH ST PAUL
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State | MN
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Zip | 55109-2949
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Country | US
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Telephone | 651-769-6437
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Fax | 651-769-6599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4444
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License Number State | MN
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