Kelly Marie Showalter, MA, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4444 Issued in MN

Practice address

8441 Wayzata Blvd Ste 140
Golden Valley, MN 55426-1366

Phone

(651) 769-6300

Fax

(651) 759-6349

NPI assigned

Nov 20, 2024

Last updated

Nov 20, 2024By 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

• Kelly Marie Reynolds Former name

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Bhsi, LLC

  • Clinical Psychologist
  • North Saint Paul, MN
  • NPI 1174635643
  Medicare reassignment NPD

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

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1467277723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2497 7TH AVE E STE 108",
            "city": "NORTH ST PAUL",
            "state": "MN",
            "postal_code": "551092949",
            "telephone_number": "651-769-6437",
            "fax_number": "651-769-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8441 WAYZATA BLVD STE 140",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261366",
            "telephone_number": "651-769-6300",
            "fax_number": "651-759-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOWALTER",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "REYNOLDS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Elizabeth Taleff Shepherd, LICSW
• Shifa Transit Services LLC
• Shifa Wellness
• Carrie A Shogren, OTRL
• Amanda Shorter, DC
• Kristen Louise Siewert, RN
• Robert Jon Sigelman, MD
• Thomas E Silver, DPM
• Paul M Silverstein, MD
• Ellen Potter Simonsen, L.P.C.C

• Professional Counselor in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.