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NPI Code Detail

MEDICARE: CAROLINE KELLY LPCC

MEDICARE: CAROLINE KELLY LPCC
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
1101YP2500XProfessional Counselor4175MN

General Provider Information

NPI Number : 1164916789
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE KELLY LPCC
Provider Business Mailing Address
First Line : 4969 OLSON MEMORIAL HWY
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-5138
Country : US
Telephone Number : 763-575-8086
Fax Number :
Provider Business Practice Location Address
First Line : 4969 OLSON MEMORIAL HWY
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-5138
Country : US
Telephone Number : 763-575-8086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 03/19/2025

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