Matthew Watnemo, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4590 Issued in MN

Practice address

6776 Lake Dr Ste 170
Lino Lakes, MN 55014-1201

Phone

(651) 356-8741

NPI assigned

Sep 16, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bridging Hope Counseling Services LLCGroup PAC ID 8527560234, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bridging Hope Counseling Services LLC

  • Clinic/Center
  • Rogers, MN
  • NPI 1598921629
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1104653005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 ROGERS DR STE 200",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6776 LAKE DR STE 170",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141201",
            "telephone_number": "651-356-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATNEMO",
        "first_name": "MATTHEW",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timberwolf Anesthesia SC
• Alaina Jean Tolzmann
• Michael Charles Tressler, M.D
• Tonya Lee Van Ee, RN
• Dale Herbert Vancil, D. P, M.
• Charyl Renee Weingarten, DDS
• Kaylen Whetstone, CCC-SLP
• Katia J Wilcox
• Loren Max Wilkes, MD
• Sarah Elizabeth Williams, M.A. CCC-SLP

• Professional Counselor in Lino Lakes, MN
• Providers in Lino Lakes, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.