Individual provider Active NPI

Carly Davis

  • Marriage & Family Therapist
  • Minneapolis, MN
National Provider Identifier
1598628406
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
3112 Hennepin Ave
Minneapolis, MN 55408-2619
Phone
(612) 293-8814
NPI assigned
Dec 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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 MN Primary

Addresses

Primary practice location

3112 Hennepin Ave
Minneapolis, MN 55408-2619

Mailing address

4712 Zenith Ave S
Minneapolis, MN 55410-1872
Phone (612) 219-7763

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
I20260205000092 MN Practitioner - Marriage and Family Therapist 5395224885 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4712 Zenith Ave S
Minneapolis, MN 55410-1872

621 W Lake St
Suite 350
Minneapolis, MN 55408-2952

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4551MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lyn-Lake Psychotherapy and Wellness LTD. CurrentSince Oct 30, 2025 Accepting new patients

Locations

3112 Hennepin Ave
Minneapolis, MN 55408
Phone (612) 293-8814

2900 Thomas Ave S
Ste 100
Minneapolis, MN 55416

621 W Lake St
Ste 350
Minneapolis, MN 55408
Phone (612) 547-9990

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": "1765152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1598628406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 ZENITH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554101872",
            "telephone_number": "612-219-7763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3112 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082619",
            "telephone_number": "612-293-8814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CARLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-08",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.