Kelly Elisa Ryan, MA, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1272 Issued in MN

Practice address

3640 Talmage Cir
Ste 210
Vadnais Heights, MN 55110-4183

Phone

(651) 493-8150

Fax

(651) 493-9335

NPI assigned

Nov 11, 2016

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

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

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 and National Provider Directory roles.

• Metanoia Therapy, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vadnais Heights, MN
  • NPI 1063050615
  Medicare reassignment NPD

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

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478822400000",
    "number": "1699217315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR",
            "address_2": "STE 210",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104183",
            "telephone_number": "651-493-8150",
            "fax_number": "651-493-9335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR",
            "address_2": "STE 210",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104183",
            "telephone_number": "651-493-8150",
            "fax_number": "651-493-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KELLY",
        "middle_name": "ELISA",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-11",
        "last_updated": "2016-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "1272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connor Patrick Richardson, M.D.
• Nathan A Riess, DPT
• Morgan Rogowski, PT
• Kaitlyn Marie Rolando, PA-C
• James Francis Ryan, DC
• Maryan Said
• Jacob James Scherber, DPT
• Cherylann Z Schistad, OTR/L, CHT
• Ryan Edward Schmidt
• Jacob T Schmitz, DPT

• Professional Counselor in Vadnais Heights, MN
• Providers in Vadnais Heights, 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 11, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.