Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Jean Tibbetts, LICSW

Individual provider Clinical Social Worker · NPI 1992350367

Kelly Jean Tibbetts, LICSW is a Clinical Social Worker in Spring Park, Minnesota. Qualified in 2016, 10 years ago. Practices with Restorative Behavioral Health Services, a 3-clinician group and works from 2 locations. Licensed in Minnesota.

Years since qualifying
10
Licensed in
MN
In the registry since
2019
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Practice location Address checks out

4154 Shoreline Dr Ste 202
Spring Park, MN 55384-5610
Phone: (952) 491-9450
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7501 80th St S, Cottage Grove, MN 55016-3020 — (218) 409-7508

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 22636 (MN)

Record details

NPI number1992350367
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedAugust 2, 2019
Last updated in NPPESJune 6, 2025
Certification dateJune 6, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Restorative Behavioral Health Services — 3 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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