MEDICARE: KELLY J KIVEL LPCC, LPC

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	856226	WI
2	101YP2500X	Professional Counselor	CC02290	MN

General Provider Information

NPI Number	:	1134565278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY J KIVEL LPCC, LPC

Provider Business Mailing Address
First Line	:	15265 CARROUSEL WAY
Second Line	:
City	:	ROSEMOUNT
State	:	MN
Zip	:	55068-1760
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	15265 CARROUSEL WAY
Second Line	:
City	:	ROSEMOUNT
State	:	MN
Zip	:	55068-1760
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:

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

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	07/18/2023

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