Individual provider Active NPI

Tara Lebaron, LPCC

  • Mental Health Counselor
  • Minneapolis, MN
National Provider Identifier
1124490453
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CC01081 Issued in MN
Practice address
621 W Lake St Ste 350
Minneapolis, MN 55408-2952
Phone
(612) 979-2276
NPI assigned
Oct 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CC01081 MN Primary

Addresses

Primary practice location

621 W Lake St Ste 350
Minneapolis, MN 55408-2952

Mailing address

621 W Lake St Ste 350
Minneapolis, MN 55408-2952

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
I20240126002611 MN Practitioner - Mental Health Counselor 7113370016 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Lyn-Lake Psychotherapy and Wellness LTDGroup PAC ID 9638581291, 72 clinicians

Practice addresses (Care Compare)

621 W Lake St
Suite 350
Minneapolis, MN 55408-2952
Phone (612) 979-2276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC01081MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Rum River Counseling, Inc. Professional CurrentSince Nov 7, 2023 Accepting new patients
Luminous Origins Therapy and Wellness LLC Current Accepting new patients
Lyn-Lake Psychotherapy and Wellness LTD. Mental Health CurrentSince Jan 30, 2024 Accepting new patients

Locations

1875 Station Pkwy NW
Andover, MN 55304

2900 Thomas Ave S
Ste 100
Minneapolis, MN 55416

621 W Lake St
Ste 350
Minneapolis, MN 55408
Phone (612) 547-9990

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": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1124490453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 W LAKE ST STE 350",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W LAKE ST STE 350",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082952",
            "telephone_number": "612-979-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBARON",
        "first_name": "TARA",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC01081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.