Willow Bay Therapy, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

3192 Issued in MN

Legal business name

WILLOW BAY THERAPY, LLC

Practice address

12805 Highway 55 Ste 216
Plymouth, MN 55441-3859

Phone

(612) 440-1450

Fax

(612) 524-5563

NPI assigned

May 31, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Joanna Lynn Kelly, MA, LMFT, RPT-SNPI 1740654888

Title

Owner/Psychotherapist

Phone

(612) 961-1015

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joanna Kelly, M.A., LMFT, RPT

  • Marriage & Family Therapist
  • Plymouth, MN
  • NPI 1740654888
  NPD Authorized official

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771804800000",
    "number": "1104354406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3933 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072843",
            "telephone_number": "612-961-1015",
            "fax_number": "612-524-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55 STE 216",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "612-440-1450",
            "fax_number": "612-524-5563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3441 Cedar Ave S",
            "address_purpose": "LOCATION",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072336",
            "country_code": "US",
            "telephone_number": "612-440-1450",
            "fax_number": "612-524-5563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILLOW BAY THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "612-961-1015",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LMFT, RPT-S"
    },
    "taxonomies": [
        {
            "code": "225XM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "3192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary L Williams, D.D.S.
• Keairra Latrece Williams
• Roshaunta Jacquese Evora Williams, BA AFRICAN AMERICAN
• Susan Ora Williams, MSW, LICSW
• Lindsay Grace Williamson, OTR/L
• Willow Creek Family Dental
• Willow Grove Family Dental
• Sandra Ann Willson, PT
• Alexander Wilson, PA STUDENT
• Anthony John Wilson

• Mental Health Clinic/Center (Including Community Mental Health Center) in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.