Individual provider Active NPI

Thu-Ha Park, LPCC

  • Professional Counselor
  • Rochester, MN
National Provider Identifier
1073915898
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC00764 Issued in MN
Practice address
300 3Rd Ave SE Ste 302
Rochester, MN 55904-4681
Phone
(507) 218-5913
NPI assigned
Sep 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC00764 MN Primary

Addresses

Primary practice location

300 3Rd Ave SE Ste 302
Rochester, MN 55904-4681

Mailing address

1103 10TH St NW
Rochester, MN 55901-1756

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
I20240501003410 MN Practitioner - Mental Health Counselor 5799125126 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Against the Grain LLCGroup PAC ID 4880034214, 3 clinicians

Practice addresses (Care Compare)

300 3Rd Ave SE
Suite 302
Rochester, MN 55904-4681
Phone (507) 218-5913

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
764MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Against the Grain LLC Professional CurrentSince Dec 20, 2023 Accepting new patients
Family Support Services Inc. Past Accepting new patients
Nystrom & Associates, LTD PastSince Oct 19, 2020 Accepting new patients

Locations

300 3rd Ave SE
Ste 302
Rochester, MN 55904
Phone (507) 218-5913

Organizations & group practices 3

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": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1073915898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 10TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559011756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 3RD AVE SE STE 302",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559044681",
            "telephone_number": "507-218-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "THU-HA",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-24",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.