Active NPI
Kelly Nichole Larson, LMFT
- Marriage & Family Therapist
- Minneapolis, MN
National Provider Identifier
1972736155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1895
- Practice address
- 310 E 38TH St Ste 320
Minneapolis, MN 55409-1338 - Phone
- (612) 243-1600
- NPI assigned
- Sep 3, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1895 | MN | Primary |
Addresses
Primary practice location
310 E 38TH St Ste 320
Minneapolis, MN 55409-1338
Mailing address
1002 6TH Ave S
Stillwater, MN 55082-5842
Phone (651) 363-0821
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 |
|---|---|---|---|
| 1895 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675036800000",
"number": "1972736155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1002 6TH AVE S",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550825842",
"telephone_number": "651-363-0821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 E 38TH ST STE 320",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554091338",
"telephone_number": "612-243-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "KELLY",
"middle_name": "NICHOLE",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-03",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.