Active NPI
Kelly C Berg, PH.D.
- Counseling Psychologist
- Saint Paul, MN
National Provider Identifier
1649610270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 5595
- Practice address
- 2230 Como Ave
Saint Paul, MN 55108-1720 - Phone
- (612) 804-2120
- NPI assigned
- Jun 27, 2013
- Last updated
- Jun 27, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 5595 | MN | Primary |
Addresses
Primary practice location
2230 Como Ave
Saint Paul, MN 55108-1720
Mailing address
5925 Ewing Ave S
Edina, MN 55410-2737
Phone (612) 804-2120
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5595 | MN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372291200000",
"number": "1649610270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5925 EWING AVE S",
"city": "EDINA",
"state": "MN",
"postal_code": "554102737",
"telephone_number": "612-804-2120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2230 COMO AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551081720",
"telephone_number": "612-804-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "KELLY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-27",
"last_updated": "2013-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "5595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.