NPIMap

Organization Active NPI

61 Experience

  • Mental Health Counselor
  • Saint Paul, MN
National Provider Identifier
1053948315
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
61 EXPERIENCE
Practice address
1 Water St W Ste 230
Saint Paul, MN 55107-2002
Phone
(612) 418-9429
NPI assigned
Mar 26, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Authorized official

Name
Ryan Eckdahl
Title
President
Phone
(612) 418-9429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1 Water St W Ste 230
Saint Paul, MN 55107-2002

Mailing address

3822 Regent Ave N
Robbinsdale, MN 55422-2019
Phone (612) 418-9429

National Provider Directory

National Provider Directory

Locations

1 Water St W
Ste 230
Saint Paul, MN 55107
Phone (612) 418-9429

NPI Registry JSON

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585180800000",
    "number": "1053948315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3822 REGENT AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222019",
            "telephone_number": "612-418-9429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WATER ST W STE 230",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551072002",
            "telephone_number": "612-418-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "61 EXPERIENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A",
        "authorized_official_last_name": "ECKDAHL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-418-9429"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.