NPIMap

Organization Active NPI

Rum River Counseling, Inc.

  • Marriage & Family Therapist
  • Andover, MN
National Provider Identifier
1073578472
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
RUM RIVER COUNSELING, INC.
Practice address
1875 Station Pkwy NW Ste 100
Andover, MN 55304-3319
Phone
(763) 482-9598
Fax
(612) 235-6447
NPI assigned
Apr 19, 2006
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Jennifer Holdredge, M.A., L.M.F.T.NPI 1932164340
Title
Owner
Phone
(763) 482-9598

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

1875 Station Pkwy NW Ste 100
Andover, MN 55304-3319

Mailing address

1875 Station Pkwy NW Ste a
Andover, MN 55304-3318
Phone (612) 382-0032

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230801001915 MN Part B Supplier - Clinic/Group Practice 0941661482 Receives reassigned benefits from 46 practitioners
Practice locations: Andover, MN

National Provider Directory

National Provider Directory

Locations

1875 Station Pkwy NW
Andover, MN 55304

1875 Station Pkwy NW
Ste 100
Andover, MN 55304

1875 Station Pkwy NW
Ste A
Andover, MN 55304

11870 Ulysses St NE
Ste 200
Blaine, MN 55434
Phone (651) 485-5428

11090 183rd Cir NW
Ste A
Elk River, MN 55330
Phone (763) 691-3430

7200 Hudson Blvd N
Ste 220
Oakdale, MN 55128

18205 45th Ave N
Ste D
Plymouth, MN 55446
Phone (214) 554-4089

14115 James Rd
Ste 305
Rogers, MN 55374
Phone (763) 575-8086

1619 Dayton Ave
Ste 201
Saint Paul, MN 55104
Phone (651) 645-5504

Practitioners & affiliated clinicians

Practitioners 79

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1073578472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW STE A",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043318",
            "telephone_number": "612-382-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW STE 100",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598",
            "fax_number": "612-235-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUM RIVER COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-11",
        "status": "A",
        "authorized_official_last_name": "HOLDREDGE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-482-9598",
        "authorized_official_credential": "M.A., L.M.F.T."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.