Active NPI
Karolyn Diller Mengershausen, LPC, LMFT
- Marriage & Family Therapist
- Burnsville, MN
National Provider Identifier
1124043088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1219
- Practice address
- 760 Southcross Drive West
Suite 103
Burnsville, MN 55306 - Phone
- (952) 835-5088
- Fax
- (952) 835-5088
- NPI assigned
- Jul 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1219 | MN | Primary |
| Professional Counselor | 101YP2500X | C1147 | OR | |
| Marriage & Family Therapist | 106H00000X | T0395 | OR |
Addresses
Primary practice location
760 Southcross Drive West
Suite 103
Burnsville, MN 55306
Mailing address
760 Southcross Drive West
Suite 103
Burnsville, MN 55306
Phone (952) 835-5088
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 976487900 | Medicaid | MN |
Other names 1
- Karolyn D. Diller
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 |
|---|---|---|---|
| C1147 | OR | MD | Professional Counselor |
| T0395 | OR | MD | Marriage & Family Therapist |
| 1219 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427241600000",
"number": "1124043088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 SOUTHCROSS DRIVE WEST",
"address_2": "SUITE 103",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "55306",
"telephone_number": "952-835-5088",
"fax_number": "952-835-5088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 SOUTHCROSS DRIVE WEST",
"address_2": "SUITE 103",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "55306",
"telephone_number": "952-835-5088",
"fax_number": "952-835-5088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENGERSHAUSEN",
"first_name": "KAROLYN",
"middle_name": "DILLER",
"credential": "LPC, LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-13",
"last_updated": "2015-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1219",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1147",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "T0395",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "976487900",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KAROLYN",
"last_name": "DILLER",
"middle_name": "D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.