Kysa Lorenc Lubovich, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3159 Issued in MN

Practice address

1935 County Road B2 W Ste 41
Roseville, MN 55113-2788

Phone

(612) 388-5897

Fax

(651) 340-3237

NPI assigned

Jul 5, 2016

Last updated

Mar 20, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kysa Lorentz Hall Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beacon Therapy Associates, PC

  • Marriage & Family Therapist
  • Champlin, MN
  • NPI 1407084031
  Medicare reassignment NPD

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1396197117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7066 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283937",
            "telephone_number": "651-401-3062",
            "fax_number": "651-674-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 COUNTY ROAD B2 W STE 41",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132788",
            "telephone_number": "612-388-5897",
            "fax_number": "651-340-3237"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7066 Stillwater Blvd N",
            "address_purpose": "LOCATION",
            "city": "Oakdale",
            "state": "MN",
            "postal_code": "551283937",
            "country_code": "US",
            "telephone_number": "651-401-3062",
            "fax_number": "651-674-2534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUBOVICH",
        "first_name": "KYSA",
        "middle_name": "LORENC",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYSA",
            "last_name": "HALL",
            "middle_name": "LORENTZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Marriage & Family Therapist in Roseville, MN
• Providers in Roseville, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.