Kelly Jean Hollingsworth, LPCC
Individual provider Active NPI Mental Health Counselor · Fairmont, MN
NPI 1073255774 · NPPES record last updated Apr 12, 2022
Key facts
- NPI
- 1073255774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 3275 (MN)
- Practice address
- 1244 Albion Ave
Fairmont, MN 56031-3139 - Phone
- (507) 236-7568
- NPI assigned
- Apr 12, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Southwestern Mental Health Center Inc
Practice addresses (Care Compare)
1210 5TH Ave
Worthington, MN 56187-2432
Phone (507) 376-4141
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240228001614 | MN | Practitioner - Mental Health Counselor | 0941645097 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwestern Mental Health Center Inc | Current |
Accepting new patients |
Locations
117 S Spring St
Luverne, MN 56156
Phone (507) 283-9511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3275 | MN | Yes |
Addresses
Primary practice location
1244 Albion Ave
Fairmont, MN 56031-3139
Mailing address
1244 Albion Ave
Fairmont, MN 56031-3139
Phone (507) 236-7568
Other providers in Fairmont, MN
- Meghan Anne Hanson
- Lexie Danielle Harmening
- Harvest Health LLC
- Hearing Health Centers, P.C.
- James Richard Hitchcock
- Javen Delano Holm
- John Daniel Holstine
- Charles Hounshell
- Human Services of Faribault & Martin Counties
- Hy-Vee Inc
All providers in Fairmont, MN · Mental Health Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.