Tasha Jeanmarie Kelly, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

2126 Vista Ave
Arnegard, ND 58835

Phone

(701) 586-3300

NPI assigned

Feb 20, 2025

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Providence House LLC

  • Substance Abuse Rehabilitation Facility
  • Arnegard, ND
  • NPI 1184367567
  NPD

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

{
    "created_epoch": "1740009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1972309086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 11TH AVE W APT 410",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588015392",
            "telephone_number": "406-491-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 VISTA AVE",
            "city": "ARNEGARD",
            "state": "ND",
            "postal_code": "58835",
            "telephone_number": "701-586-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TASHA",
        "middle_name": "JEANMARIE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-20",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Owen Hamre
• Devan W.W. Johnson, LAC
• LGND Rehab & Performance PLLC
• Lindsey Nicole Page, LAC
• Anita Ann Pedersen, FNP-BC
• Providence House LLC
• Randi Smith

• All providers in Arnegard, ND
• Addiction (Substance Use Disorder) Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; 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.