MR. MICHAEL CASHMAN KELLY (NPI# 1629281530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629281530 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL CASHMAN KELLY |
| Other Name | MR. MICHAEL PATRICK KELLY |
| Credential | MS - LP |
| Practice Address |
2025 Stearns Way Saint Cloud MN 56303-4491 |
| Mailing Address |
3600 W Saint Germain St Apt 256 Saint Cloud MN 56301-4639 |
| Practice Telephone | 3202291500 |
| Practice Fax Number | 3202291505 |
| Mailing Telephone | 3202300191 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
LP 4136 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | EMPLOYEE ID FOR STATE OF | 00189405 | 01 |
| MN | UNITED BEHAVIORAL HEALTH | 62 - 64674 | 01 |
| MN | VALUE OPTIONS | 517402 | 01 |
| MN | B.H.S.I. | 13H51876KE | 01 |
| MN | BLUE CROSS- BLUE SHIELD | 422T6KE | 01 |
| MN | MN EMPLOYEE ID NUMBER | 00189405 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699389874 | Michael Kelly | Physical Therapist | 1025 Service Pl Ste 200, Vista, CA 92084-7271 | 2020-09-03 |
| 1871949115 | Michael John Kelly | Speech-Language Pathologist | 3484 Fair Oaks Ave, Bowling Green, KY 42104-5529 | 2016-05-05 |
| 1003206004 | Michael Sean Kelly | Nurse Practitioner | 17601 17th St Ste 120, Tustin, CA 92780-1946 | 2015-01-28 |
| 1295135515 | Michael Kelly | Technician, Other | 2215 E 36 1/2 St, Minneapolis, MN 55407-3018 | 2014-08-25 |
| 1225310675 | Michael Thomas Kelly | Pathology | 4156 H Street Rd, Blaine, WA 98230-9228 | 2011-09-12 |
| 1205085073 | Michael H Kelly | Massage Therapist | 76 Bosse Ln, West Seneca, NY 14224-1624 | 2008-09-16 |
| 1275780041 | Michael Foster Kelly | Acupuncturist | 8 Wells Ave, Yonkers, NY 10701-2710 | 2008-08-25 |
| 1346458031 | Michael Francis Kelly | Registered Nurse | 79 Trausneck Pl, Yonkers, NY 10703-1907 | 2007-05-18 |
| 1104045707 | Michael Walter Kelly | Pharmacist | College of Pharmacy, 110 Pharmacy Building, Iowa City, IA 52242-1112 | 2007-04-24 |
| 1710105358 | Michael Kelly | Physical Therapist | 1600 E. Jefferson St., Seattle, WA 98122 | 2007-04-20 |
| Street Address |
2025 STEARNS WAY |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-4491 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003897133 | Karenthea W. Rouw | Podiatrist | 2025 Stearns Way, #105, Saint Cloud, MN 56303-4491 | 2005-11-07 |
| 1245645688 | De Ella Dawn Wilcox | Social Worker | 2025 Stearns Way, Suite 111, Saint Cloud, MN 56303-4491 | 2014-06-24 |
| 1083025712 | Dbt Specialists P.a. | Counselor | 2025 Stearns Way, Suite 105, Saint Cloud, MN 56303-4491 | 2014-05-15 |
| 1497083000 | Debra Elizabeth Stumvoll | Psychologist | 2025 Stearns Way, Suite 111, Saint Cloud, MN 56303-4491 | 2009-11-20 |
| 1285811612 | Central Minnesota Foot and Ankle Pllc | Durable Medical Equipment & Medical Supplies | 2025 Stearns Way, Suite 105, Saint Cloud, MN 56303-4491 | 2008-01-29 |
| 1861531659 | Allen Zetterlund | Physical Therapist | 2025 Stearns Way, Suite 114, Saint Cloud, MN 56303-4491 | 2007-02-06 |
| 1891862488 | Cindy Lee Koubsky | Marriage & Family Therapist | 2025 Stearns Way, Saint Cloud, MN 56303-4491 | 2006-11-29 |
| 1376614586 | Sandra C. Reese | Clinical Neuropsychologist | 2025 Stearns Way, Suite 111, Saint Cloud, MN 56303-4491 | 2006-11-10 |
| 1508847633 | Gregory R. Rouw | Podiatrist | 2025 Stearns Way, #105, Saint Cloud, MN 56303-4491 | 2005-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316178296 | Elaine Marie Miller | Psychologist | 3604 S Oak Cir, Saint Cloud, MN 56301-4616 | 2009-07-27 |
| 1043860109 | St. Cloud Neurobehavioral Associates, Pa | Psychologist | 3812 8th St N Ste 200, Saint Cloud, MN 56303-1421 | 2019-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347854 | Shining Light Skill Building LLC | Psychologist | 3055 Old Highway 8 Ste 106b, St. Anthony, MN 55418 | 2020-08-17 |
| 1245750652 | Sara Vaccarella | Psychologist | 331 W Superior St Ste 300, Duluth, MN 55802-4532 | 2017-06-27 |
| 1780124305 | Families First Counseling Services LLC | Psychologist | 103 S Kingston St, Caledonia, MN 55921-1315 | 2017-03-01 |
| 1598150930 | Nova Bhs | Psychologist | 521 Tanglewood Dr., Shoreview, MN 55126 | 2015-04-02 |
| 1801208566 | Rose Mary Boerboom | Psychologist | 415 N 1st St, #502, Minneapolis, MN 55401-4305 | 2014-05-28 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1992145288 | Rowan P Buckley | Psychologist | 6825 Owen St Ste 201, Loretto, MN 55357-9713 | 2013-07-01 |
| 1063781771 | Julie Ann Gomer | Psychologist | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2011-12-26 |
| 1750697587 | Megan Horwitz Plumstead | Psychologist | 1619 Dayton Ave Ste 327, Saint Paul, MN 55104-6495 | 2010-08-31 |
| 1073826913 | Scott Michael Jacoby | Psychologist | 2110 Lyndale Ave S, Minneapolis, MN 55405-3196 | 2010-07-20 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
Please comment or provide details below to improve the information on MR. MICHAEL CASHMAN KELLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.