KAYLIE BROBERG - NPI 1053824748 - Marriage & Family Therapist in Plymouth, MN

Q: What is Kaylie Broberg's NPI number?

The NPI number for Kaylie Broberg is 1053824748. It was assigned to this individual provider in the NPPES registry on November 16, 2017.

Q: What is Kaylie Broberg's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: Is Kaylie Broberg enrolled in Medicare?

No. Kaylie Broberg has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Kaylie Broberg was last updated on December 28, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Kaylie Broberg NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAYLIE BROBERG (NPI 1053824748) is an individual marriage & family therapist in Plymouth, Minnesota, licensed in Minnesota (3775) and active in the NPI registry since November 2017. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1053824748

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameKAYLIE BROBERG

Location Address9800 SHELARD PKWY STE 115Plymouth, MN 55441-6411

Mailing Address9800 Shelard Pkwy Ste 115Plymouth, MN 55441-6411

Phone(651) 447-7507

Fax(763) 432-6001

Sole ProprietorNo

Enumeration DateNovember 16, 2017

Last NPPES UpdateDecember 28, 20214 updates tracked since enumeration

NPPES CertifiedNovember 29, 2021

✔ NPI 1053824748 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in MN · 3775

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

9800 SHELARD PKWY STE 115, Plymouth, MN 55441

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kaylie Broberg has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024

Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LISA ANNE SCHWARTZ

Marriage & Family Therapist