Active NPI
Katherine Jane Flynn, LPC, LADC
- Professional Counselor
- St Louis Park, MN
National Provider Identifier
1700958295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 00065
- Practice address
- 5009 Excelsior Blvd Ste 134
St Louis Park, MN 55416-3049 - Phone
- (612) 819-5326
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300107 | MN | |
| Professional Counselor | 101YP2500X | 00065 | MN | Primary |
Addresses
Primary practice location
5009 Excelsior Blvd Ste 134
St Louis Park, MN 55416-3049
Mailing address
5009 Excelsior Blvd Ste 134
St Louis Park, MN 55416-3049
Phone (612) 819-5326
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300107 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 00065 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338336000000",
"number": "1700958295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5009 EXCELSIOR BLVD STE 134",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554163049",
"telephone_number": "612-819-5326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5009 EXCELSIOR BLVD STE 134",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554163049",
"telephone_number": "612-819-5326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLYNN",
"first_name": "KATHERINE",
"middle_name": "JANE",
"credential": "LPC, LADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2012-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "300107",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "00065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.