Life Interrupted Counseling Services

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

LIFE INTERRUPTED COUNSELING SERVICES

Practice address

1500 McAndrews Rd W Ste 215
Burnsville, MN 55337-4445

Phone

(952) 222-3002

NPI assigned

Dec 15, 2022

Organization subpart

No

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

Authorized official

Name

Mary L Chedda, MM, MA, LMFTNPI 1861931966

Title

Ceo/Sole Proprietor

Phone

(651) 338-8643

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Lisa Chedda, MA, LMFT

  • Marriage & Family Therapist
  • Burnsville, MN
  • NPI 1861931966
  Medicare reassignment NPD Authorized official
• Scott Fisk, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Coon Rapids, MN
  • NPI 1962207407
  Medicare reassignment NPD

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1033821632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W STE 215",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374445",
            "telephone_number": "651-338-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MCANDREWS RD W STE 215",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374445",
            "telephone_number": "952-222-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE INTERRUPTED COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "CHEDDA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/SOLE PROPRIETOR",
        "authorized_official_telephone_number": "651-338-8643",
        "authorized_official_credential": "MM, MA, LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1861931966",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861931966",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lexi Miller
• Cari Ann Libby
• Jessica Suzanne Kim Lien, M.D.
• Jessica Rose Liepke, RN
• Life Counseling LLC
• Life Renewal Counseling LLC
• Life Time Transportation LLC
• Lifeborne Health LLC
• Lifespan of Minnesota, Inc.
• Lifetime Health Care Services Inc

• Adolescent and Children Mental Health Clinic/Center in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.