Provider Demographics
NPI:1265828685
Name:MATSON, KELLY (LPCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MATSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8401 WAYZATA BLVD
Mailing Address - Street 2:SUITE
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1343
Mailing Address - Country:US
Mailing Address - Phone:763-544-1006
Mailing Address - Fax:763-544-1008
Practice Address - Street 1:510 N CHESTNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3300
Practice Address - Country:US
Practice Address - Phone:952-361-3360
Practice Address - Fax:952-513-7968
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCC00970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health