KEVIN GORDON CARLSON LPCC, LADC
NPI 1205647740
Counselor - Professional in Fridley, MN
About Kevin Gordon Carlson Lpcc, Ladc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KEVIN GORDON CARLSON LPCC, LADC (NPI 1205647740) is an individual professional provider in Fridley, Minnesota, licensed in Minnesota (4790) and active in the NPI registry since January 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kevin Gordon Carlson Lpcc, Ladc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kevin Carlson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Minneapolis, MN 55408
- Reassigned Medicare billing, Minnesota enrollment
- 152 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 11
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FRIDLEY, MN 55432
FRIDLEY, MN 55432
FRIDLEY, MN 55432
FRIDLEY, MN 55432
FRIDLEY, MN 55432
FRIDLEY, MN 55432
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kevin Carlson's NPI number?
The NPI number for Kevin Carlson is 1205647740. It was assigned to this individual provider in the NPPES registry on January 15, 2025.
Where is Kevin Carlson located?
Kevin Carlson practices at 520 Osborne Rd NE Ste 120, Fridley, MN 55432. The listed phone number is (763) 236-4300.
What is Kevin Carlson's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Kevin Carlson enrolled in Medicare?
Yes. Kevin Carlson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kevin Carlson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kevin Carlson reassigns Medicare benefits to Lyn-Lake Psychotherapy And Wellness Ltd. (Minneapolis, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kevin Carlson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kevin Carlson accept?
Health plans from HealthPartners list Kevin Carlson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kevin Carlson was last updated on February 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kevin Gordon Carlson, LPCC, LADC · NPI 1205647740
Professional provider in Fridley, Minnesota. Individual provider, active in the CMS NPPES registry since January 15, 2025.
## Identity
- **NPI:** 1205647740 (Entity type: Individual)
- **Enumerated:** January 15, 2025
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 4790 (Minnesota)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 520 OSBORNE RD NE STE 120, Fridley, MN 55432-2718
- **Phone:** (763) 236-4300
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Lyn-Lake Psychotherapy And Wellness Ltd. (NPI 1609355163, Minneapolis, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** February 3, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1205647740) · Data from the CMS NPPES public registry.