Kelly Vourlos, MSW, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

15164 Issued in MN

Practice address

10505 Wayzata Blvd Ste 101
Minnetonka, MN 55305-1507

Phone

(952) 484-2020

Fax

(952) 492-7885

NPI assigned

Mar 11, 2015

Last updated

Jul 22, 2019By the provider in NPPES

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

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

River Valley Behavioral Health and Wellness Center, PLLCGroup PAC ID 3678625035, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• River Valley Behavioral Health & Wellness Center, PLLC

  • Counseling Psychologist
  • Savage, MN
  • NPI 1316197148
  Medicare reassignment Care Compare group NPD
• Faithworks Counseling, LLC

  dba Anchor Counseling

  • Marriage & Family Therapist
  • Jordan, MN
  • NPI 1235377656
  NPD (past)

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1760875082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 LODGE DR",
            "city": "JORDAN",
            "state": "MN",
            "postal_code": "553521453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 WAYZATA BLVD STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051507",
            "telephone_number": "952-484-2020",
            "fax_number": "952-492-7885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Seville Dr. Ste. 205",
            "address_purpose": "LOCATION",
            "city": "Jordan",
            "state": "MN",
            "postal_code": "55352",
            "country_code": "US",
            "telephone_number": "955-484-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8640 Eagle Creek Cir",
            "address_purpose": "LOCATION",
            "city": "Savage",
            "state": "MN",
            "postal_code": "553784400",
            "country_code": "US",
            "telephone_number": "952-746-7664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VOURLOS",
        "first_name": "KELLY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-11",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "15164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Volunteers of America Home Health Services
• Volunteers of America MN (Children's REsidential Treatment Center)
• Julia Vongphachanh
• Barry Voroba, PH.D.
• Jeanette Laverne Vought, PHD, LP
• Matthew Vradenburg, DC
• Carmen Lynn Vriezema, AC/ AGPCNP-BC
• Sarah Marie Waech
• William Walton Wagnild, DDS
• Samantha Andrea Wakefield, FNP-BC

• Social Worker in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.

Verify at the official NPI Registry.