ROBERTA RIDYN KELLEY LMFT
NPI 1538831987
Marriage & Family Therapist in Plymouth, MN

Q: What is Roberta Kelley's NPI number?

The NPI number for Roberta Kelley is 1538831987. It was assigned to this individual provider in the NPPES registry on October 4, 2021.

Q: What is Roberta Kelley's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Roberta Kelley was last updated on June 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since October 04, 2021PECOS EnrolledAccepts Medicare Assignment

3007 HARBOR LN N STE 1600, PLYMOUTH, MN 55447(612) 915-0049 Get Directions Write a Review

NPPES record last updated: June 12, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 12, 2025, May 19, 2025, Apr 8, 2024 and 1 more (4 updates tracked since 2021).

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About Roberta Ridyn Kelley Lmft NPPES

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

ROBERTA RIDYN KELLEY LMFT (NPI 1538831987) is an individual marriage & family therapist in Plymouth, Minnesota, licensed in Minnesota (4461) and active in the NPI registry since October 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1538831987

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameROBERTA RIDYN KELLEYCredential: LMFT

Location Address3007 HARBOR LN N STE 1600Plymouth, MN 55447-5142

Mailing Address4800 N Scottsdale Rd Ste 2500Scottsdale, AZ 85251-7630 · (612) 915-0049

Phone(612) 915-0049

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateOctober 4, 2021

Last NPPES UpdateJune 12, 20254 updates tracked since enumeration

NPPES CertifiedJune 12, 2025

✔ NPI 1538831987 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in MN · 4461

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.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 305002 (MN)

3007 HARBOR LN N STE 1600, Plymouth, MN 55447

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Roberta Ridyn Kelley Lmft is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7315373396

PECOS Enrollment IDI20250620000148

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 4

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

MONICA GUZDKIEWICZ DAUGHERTY APRN, CNM, PMHNP

Nurse Practitioner (Psychiatric/Mental Health)

3007 HARBOR LN N STE 1600
PLYMOUTH, MN 55447

Hennepin County (763) 230-2917

LAURA HOLMBERG LPCC

Counselor (Professional)

3007 HARBOR LN N STE 1600
PLYMOUTH, MN 55447

Hennepin County (763) 230-2917

PAMELA STANCHFIELD LCSW

Social Worker (Clinical)

3007 HARBOR LN N STE 1600
PLYMOUTH, MN 55447

Hennepin County (612) 915-0049

RAKIYA MUKHTAR SHEIKHALI

Social Worker (Clinical)

3007 HARBOR LN N STE 1600
PLYMOUTH, MN 55447

Hennepin County (877) 657-4173

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 Roberta Kelley's NPI number?

The NPI number for Roberta Kelley is 1538831987. It was assigned to this individual provider in the NPPES registry on October 4, 2021.

Where is Roberta Kelley located?

Roberta Kelley practices at 3007 Harbor Ln N Ste 1600, Plymouth, MN 55447. The listed phone number is (612) 915-0049.

What is Roberta Kelley's specialty?

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

Is Roberta Kelley enrolled in Medicare?

Yes. Roberta Kelley is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Roberta Kelley was last updated on June 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.