Individual provider Active NPI

Kelsey Elaine Larson, MA

  • Marriage & Family Therapist
  • Elk River, MN
National Provider Identifier
1669190807
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
18336 Joplin St NW
Elk River, MN 55330-1773
Phone
(320) 761-7009
NPI assigned
Aug 15, 2022
Last updated
Aug 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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 Primary

Addresses

Primary practice location

18336 Joplin St NW
Elk River, MN 55330-1773

Mailing address

1784 134TH LN NW
Andover, MN 55304-7629
Phone (320) 761-7009

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
I20240321001841 MN Practitioner - Marriage and Family Therapist 2264879600 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4372MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Regroup Counseling and Consulting PSC Marriage & Family Therapist CurrentSince Feb 1, 2024 Accepting new patients

Locations

586 Dodge Ave NW
Ste B
Elk River, MN 55330
Phone (763) 350-9687

18336 Joplin St NW
Elk River, MN 55330
Phone (763) 350-9687

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

NPI Registry JSON

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

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1669190807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1784 134TH LN NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553047629",
            "telephone_number": "320-761-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18336 JOPLIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301773",
            "telephone_number": "320-761-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "KELSEY",
        "middle_name": "ELAINE",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk River, MN

Sources for this page

Verify at the official NPI Registry.