Kelly Lee Rose, LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3701 Shoreline Dr Ste 102a
102A
Wayzata, MN 55391-4000

Phone

(651) 231-7471

NPI assigned

Jul 3, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeshore Family Therapy LLCGroup PAC ID 3577081819, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeshore Family Therapy LLC

  • Marriage & Family Therapist
  • Wayzata, MN
  • NPI 1699179994
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1003170143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 SHORELINE DR STE 102A",
            "address_2": "102A",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553914000",
            "telephone_number": "651-231-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 SHORELINE DR STE 102A",
            "address_2": "102A",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553914000",
            "telephone_number": "651-231-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-03",
        "last_updated": "2024-05-30",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2494",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Restore Family Chiropractic LLC
• Richard L Salmela DDS PA
• RJF Counseling Inc
• Bryan Nicholas Rolfes, M.D.
• Rooted in Strength Counseling PLLC
• William Oscar Rose, LP, LMFT
• David M Ross, MD
• Jessica Nicole Roth, DC
• Devan Kristine Rubio, LPCC
• Roxanna Louise Rutter, PH.D.

• Mental Health Counselor in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.