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

Kelly Simon

Individual provider Mental Health Counselor · NPI 1164916151

Kelly Simon is a Mental Health Counselor in Maple Grove, Minnesota. Qualified in 2014, 12 years ago. Practices as a sole proprietor and accepts Medicare assignment.

Years since qualifying
12
In the registry since
2018
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Practice location Address checks out

12918 63rd Ave N
Maple Grove, MN 55369-6001
Phone: (612) 554-3737
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1164916151
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 21, 2018
Last updated in NPPESJanuary 8, 2026
Certification dateJanuary 8, 2026
Mailing address4624 Deerwood Dr, Minnetonka, MN 55343-8679

Medicare enrollment

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

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Maple Grove