Jonathan Kodet, PHD,LP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6186 Issued in MN

Practice address

1850 W Wayzata Blvd # 220
Long Lake, MN 55356-4413

Phone

(612) 520-1244

NPI assigned

Sep 1, 2016

Last updated

Mar 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

• Centering Your Life Psychology PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Long Lake, MN
  • NPI 1932856408
  NPD Authorized official

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1750838181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 W WAYZATA BLVD # 220",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553564413",
            "telephone_number": "612-520-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W WAYZATA BLVD # 220",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553564413",
            "telephone_number": "612-520-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODET",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "PHD,LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "6186",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "6186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103TC0700X",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Connery, DC
• Riley Sean Cullinane, DC
• Douglas J McNaught D D S P a (Long Lake Dental)
• Stephanie Drake, D.D.S.
• Alissa Huhn, PHARMD
• Nichole Hirsch Kuechle, HOLISTIC PRACTITIONE
• Lake Minnetonka Counseling
• Lakeside Counseling
• Brianne Levandoski
• Lisa Bonahoom LLC

• Counseling Psychologist in Long Lake, MN
• Providers in Long Lake, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.