Active NPI
Angela Ann Lumbar, PSYD,LP
- Psychologist
- Willmar, MN
National Provider Identifier
1700972320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP4330
- Practice address
- 115 Litchfield Ave SE
Willmar, MN 56201-3476 - Phone
- (203) 522-1411
- NPI assigned
- Oct 4, 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | LP4330 | MN | |
| Forensic Psychologist | 103TF0200X | LP4330 | MN | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | LP4330 | MN | |
| Psychologist | 103T00000X | LP4330 | MN | Primary |
| Group Psychotherapy Psychologist | 103TP2701X | LP4330 | MN | |
| Clinical Psychologist | 103TC0700X | LP4330 | MN | |
| Counseling Psychologist | 103TC1900X | LP4330 | MN |
Addresses
Primary practice location
115 Litchfield Ave SE
Willmar, MN 56201-3476
Mailing address
PO Box 396
Fairfax, MN 55332-0361
Phone (320) 522-1411
Other practice location 1
100 4th Street SE
Fairfax, MN 55332-0361
Phone (320) 522-1411
Other names 1
- Angela Ann Kennedy
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1997
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
115 Litchfield Ave SE
Suite 103
Willmar, MN 56201-3476
Phone (320) 522-1411
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4330 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grateful Heart Counseling LLC | Clinical | Current | Accepting new patients |
| Western Mental Health Center, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/wmhcinc/r4/
Organizations & group practices 2
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.
-
- Clinical Psychologist
- Willmar, MN
- NPI 1255906780
-
- Mental Health Counselor
- Marshall, MN
- NPI 1982613311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692316800000",
"number": "1700972320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 396",
"city": "FAIRFAX",
"state": "MN",
"postal_code": "553320361",
"telephone_number": "320-522-1411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 LITCHFIELD AVE SE",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562013476",
"telephone_number": "203-522-1411"
}
],
"practiceLocations": [
{
"address_1": "100 4th Street SE",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "MN",
"postal_code": "553320361",
"country_code": "US",
"telephone_number": "320-522-1411",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUMBAR",
"first_name": "ANGELA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSYD,LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2023-08-18",
"certification_date": "2021-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MN",
"license": "LP4330",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MN",
"license": "LP4330",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "MN",
"license": "LP4330",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP4330",
"primary": true
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "MN",
"license": "LP4330",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4330",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP4330",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ANGELA",
"last_name": "KENNEDY",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.