| Doctor Name: | KELLY MATSON |
| NPI Number: | 1265828685 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | CC00970 |
| Business Practice Address: | 510 N Chestnut St Suite 201 Chaska, MN - 553183300 |
| Business Phone Number: | 9523613360 |
| Business Fax Number: | 9525137968 |
| Mailing Address: | 8401 Wayzata Blvd, Suite GOLDEN VALLEY |
| State: | MN |
| Postal Code: | 554261343 |
| Phone Number: | 7635441006 |
| Fax Number: | 7635441008 |
| NPI Enumeration Date: | 04/13/2015 |
| NPI Last Update Date: | 04/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | CC00970 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |