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

Kyle Johannessen, LPCC

Individual provider Professional Counselor · NPI 1851923445

Kyle Johannessen, LPCC is a Mental Health Counselor in Coon Rapids, Minnesota. Qualified in 2016, 10 years ago. Practices with Fraser Child and Family Center, a 55-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
10
Licensed in
MN
In the registry since
2020
What do these letters mean?
LPCC — Licensed Professional Clinical Counselor
The title some states use for a licensed clinical counsellor.

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Practice location Address checks out

9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845
Phone: (612) 767-7222
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4849 Ivanhoe St, Duluth, MN 55804-1131 — (218) 728-7418

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence CC02342 (MN)

Record details

NPI number1851923445
Entity typeIndividual (Type 1)
GenderMale
Credentials LPCC
Sole proprietorNo
NPI enumeratedFebruary 11, 2020
Last updated in NPPESSeptember 5, 2024
Certification dateSeptember 5, 2024
Mailing address9120 Springbrook Dr Nw, Coon Rapids, MN 55433-5845

Medicare enrollment

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

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Fraser Child And Family Center — 55 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Coon Rapids