Lakeville Family Therapy

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

19327 Issued in MN

Legal business name

LAKEVILLE FAMILY THERAPY

Practice address

17595 Kenwood TRL
Suite 210
Lakeville, MN 55044-9226

Phone

(612) 750-0263

NPI assigned

Mar 4, 2013

Last updated

Mar 4, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathleen Marie Kelly, MSW, LICSWNPI 1972800753

Title

Owner

Phone

(612) 750-0263

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kathleen Kelly

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1972800753
  NPD (past) Authorized official

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

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1114268943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17595 KENWOOD TRL",
            "address_2": "SUITE 210",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449226",
            "telephone_number": "612-750-0263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17595 KENWOOD TRL",
            "address_2": "SUITE 210",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449226",
            "telephone_number": "612-750-0263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVILLE FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-750-0263",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "19327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972800753",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeville Dental Associates, PA
• Lakeville Family Dental Center, P.L.L.C.
• Lakeville Family Dental Centre PA
• Lakeville Family Eye Care LLC
• Lakeville Family Health Clinic, LTD
• Lakeville Foot and Ankle Practice PLLC
• Lakeville Integrated Health Clinic Inc.
• Lakeville Integrative Medicine Clinic
• Lakeville Modern Dentistry, PLLC
• Lakeville Orthodontic Associates LLC

• Community/Behavioral Health Agency in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; 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.