Individual provider Active NPI

Christy L Kane, LAMFT

  • Marriage & Family Therapist
  • Champlin, MN
National Provider Identifier
1376268284
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
4331 Issued in MN
Practice address
11188 Zealand Ave N
Champlin, MN 55316-3594
Phone
(763) 401-7318
Fax
(763) 220-6025
NPI assigned
Oct 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 4331 MN Primary

Addresses

Primary practice location

11188 Zealand Ave N
Champlin, MN 55316-3594

Mailing address

16219 Iodine St NW
Ramsey, MN 55303-6127
Phone (763) 232-1746

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250106002494 MN Practitioner - Marriage and Family Therapist 6800324716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Soul Work Counseling, LLCGroup PAC ID 4789910233, 12 clinicians

Practice addresses (Care Compare)

11188 Zealand Ave N
Champlin, MN 55316-3594
Phone (763) 746-0842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4331MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Soul Work Counseling, LLC CurrentSince Sep 28, 2024 Accepting new patients

Locations

11188 Zealand Ave N
Champlin, MN 55316
Phone 7637460842 ext. 1

11925 Highway 65 NE
Minneapolis, MN 55434
Phone (763) 746-0842

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1376268284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16219 IODINE ST NW",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "553036127",
            "telephone_number": "763-232-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11188 ZEALAND AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163594",
            "telephone_number": "763-401-7318",
            "fax_number": "763-220-6025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANE",
        "first_name": "CHRISTY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LAMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-04",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

Verify at the official NPI Registry.