Individual
MR. MICHAEL CASHMAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS - LP
Contact information
Practice address
2025 STEARNS WAY, SAINT CLOUD, MN 56303-4491
(320) 229-1500
(320) 229-1505
Mailing address
3600 W SAINT GERMAIN ST APT 256, SAINT CLOUD, MN 56301-4639
(320) 230-0191
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP 4136
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00189405
EMPLOYEE ID FOR STATE OF
MN
01
—
13H51876KE
B.H.S.I.
MN
01
—
422T6KE
BLUE CROSS- BLUE SHIELD
MN
01
—
517402
VALUE OPTIONS
MN
01
—
62 - 64674
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
05/07/2007
Last updated
07/08/2007
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