Individual provider Active NPI

Brooke L. Zupancich, MS, LPCC

  • Mental Health Counselor
  • Virginia, MN
National Provider Identifier
1063983146
Registry record updated Dec 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
02000 Issued in MN
Practice address
624 13TH St S
Virginia, MN 55792-3149
Phone
(218) 749-2881
Fax
(218) 749-3806
NPI assigned
Dec 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 02000 MN Primary

Addresses

Primary practice location

624 13TH St S
Virginia, MN 55792-3149

Mailing address

PO Box 1188
Virginia, MN 55792-1188
Phone (218) 749-2881

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240305002955 MN Practitioner - Mental Health Counselor 4789029349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Range Mental Health CenterGroup PAC ID 3173434628, 17 clinicians

Practice addresses (Care Compare)

624 13TH St S
Virginia, MN 55792-3149
Phone (218) 749-2881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
02000MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Range Mental Health Center CurrentSince Jan 1, 2024 Accepting new patients
Range Mental Health Center Inc Past Accepting new patients

Locations

624 13th St S
Virginia, MN 55792
Phone (218) 749-2881

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544918400000",
    "number": "1063983146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557921188",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 13TH ST S",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557923149",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUPANCICH",
        "first_name": "BROOKE",
        "middle_name": "L.",
        "credential": "MS, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "02000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia, MN

Sources for this page

Verify at the official NPI Registry.