Active NPI
Michael Cashman Kelly, MS - LP
- Cognitive & Behavioral Psychologist
- Saint Cloud, MN
National Provider Identifier
1629281530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- LP 4136
- Practice address
- 2025 Stearns Way
Saint Cloud, MN 56303-4491 - Phone
- (320) 229-1500
- Fax
- (320) 229-1505
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | LP 4136 | MN | Primary |
Addresses
Primary practice location
2025 Stearns Way
Saint Cloud, MN 56303-4491
Mailing address
3600 W Saint Germain St Apt 256
Saint Cloud, MN 56301-4639
Phone (320) 230-0191
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 517402 | Other | MN | VALUE OPTIONS |
| 62 - 64674 | Other | MN | UNITED BEHAVIORAL HEALTH |
| 00189405 | Other | MN | EMPLOYEE ID FOR STATE OF |
| 422T6KE | Other | MN | BLUE CROSS- BLUE SHIELD |
| 00189405 | Other | MN | MN EMPLOYEE ID NUMBER |
| 13H51876KE | Other | MN | B.H.S.I. |
Other names 1
- Mr. Michael Patrick Kelly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 4136 | MN | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629281530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 W SAINT GERMAIN ST APT 256",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563014639",
"telephone_number": "320-230-0191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 STEARNS WAY",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034491",
"telephone_number": "320-229-1500",
"fax_number": "320-229-1505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MICHAEL",
"middle_name": "CASHMAN",
"name_prefix": "Mr.",
"credential": "MS - LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MN",
"license": "LP 4136",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "517402",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "62 - 64674",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPLOYEE ID FOR STATE OF",
"identifier": "00189405",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS- BLUE SHIELD",
"identifier": "422T6KE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN EMPLOYEE ID NUMBER",
"identifier": "00189405",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B.H.S.I.",
"identifier": "13H51876KE",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MICHAEL",
"last_name": "KELLY",
"middle_name": "PATRICK",
"prefix": "MR.",
"credential": "NONE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.