Active NPI
Ilyne Sandas, MALP
- Mental Health Counselor
- Eden Prairie, MN
National Provider Identifier
1114007382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LP3248
- Practice address
- 9531 W 78TH St
125
Eden Prairie, MN 55344-3810 - Phone
- (952) 941-2889
- Fax
- (952) 402-9326
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LP3248 | MN | Primary |
Addresses
Primary practice location
9531 W 78TH St
125
Eden Prairie, MN 55344-3810
Mailing address
8141 Maplewood Ter
Chanhassen, MN 55317-9661
Phone (952) 941-2889
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22G21SA | Other | MN | BLUE CROSS BLUE SHIELD OF |
| 62-90595 | Other | MN | MEDICA |
| 1045950000 | Medicaid | FM | |
| 937020 | Other | MN | PREFERRED ONE |
| 81860 | Other | MN | HEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3248 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114007382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8141 MAPLEWOOD TER",
"city": "CHANHASSEN",
"state": "MN",
"postal_code": "553179661",
"telephone_number": "952-941-2889",
"fax_number": "952-401-9326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9531 W 78TH ST",
"address_2": "125",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443810",
"telephone_number": "952-941-2889",
"fax_number": "952-402-9326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDAS",
"first_name": "ILYNE",
"name_prefix": "Mrs.",
"credential": "MALP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "LP3248",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF",
"identifier": "22G21SA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "62-90595",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1045950000",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "937020",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "81860",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.