Kirby Kaczor, LPCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

4263 Issued in MN

Practice address

2025 4TH St Ste 100
White Bear Lake, MN 55110-2875

Phone

(651) 212-4920

NPI assigned

Jan 31, 2024

Last updated

Jan 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vantage Mental HealthGroup PAC ID 4587104815, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vantage Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oak Park Heights, MN
  • NPI 1538990288
  Medicare reassignment Care Compare group NPD
• Collaborative Psychiatric Services LLC

  • Psychiatry Physician
  • Oak Park Heights, MN
  • NPI 1699525857
  Medicare reassignment NPD
• Wild Tree Psychotherapy, LLC

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1528451408
  Medicare reassignment NPD
• Sarah C. Chambers, P.a.

  dba Crocus Hill Health Center

  • Health Service Clinic/Center
  • Saint Paul, MN
  • NPI 1942358379
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1003679234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 4TH ST STE 100",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102875",
            "telephone_number": "651-212-4920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 4TH ST STE 100",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102875",
            "telephone_number": "651-212-4920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4432 Chicago Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554073521",
            "country_code": "US",
            "telephone_number": "612-870-2454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KACZOR",
        "first_name": "KIRBY",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "4263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Norman Jorgenson, PHARM. D.
• Dean Boyd Joy, D.C.
• Patrick Louis Jozwiak Jr., D.C.
• Logan Amory June, MSW, LICSW
• James Casey Kachel Slanga, MA LP
• Steven Kahn, PH.D
• Amy Marie Kalu, RN
• Charles Francis Kaminski Jr., DDS
• Suzanne M Kappel Geib, DDS
• Kathleen B Keane, LP

• Counselor in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.