Kevin Gordon Carlson, LPCC, LADC
NPI 1205647740ActiveIndividual· Counselor, Professional· Fridley, MN
Counselor, Professional (LPCC, LADC) with Lyn-Lake Psychotherapy and Wellness Ltd, practicing in Fridley, Minnesota. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1205647740 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LPCC, LADC |
| Sole proprietor | Yes |
| NPI issued | Jan 15, 2025 |
| Last updated in NPPES | Feb 3, 2025 |
| Certified by provider | Feb 3, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 4790 | MN |
| Counselor, Addiction (Substance Use Disorder) | 101YA0400X | 305394 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (MN) |
|---|
Education and affiliations
| Graduation year | 2021 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Lyn-Lake Psychotherapy and Wellness LtdMinneapolis, MN · 76 clinicians
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