Individual provider Active NPI

Sarah Marie Kuball

  • Mental Health Counselor
  • Edina, MN
National Provider Identifier
1134615289
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4763 Issued in MN
Practice address
6600 France Ave S Ste 425
Edina, MN 55435-1808
Phone
(952) 243-8300
NPI assigned
Jul 2, 2018
Last updated
Jan 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MN
Mental Health Counselor 101YM0800X 4763 MN Primary
Behavior Technician 106S00000X NU

Addresses

Primary practice location

6600 France Ave S Ste 425
Edina, MN 55435-1808

Mailing address

647 13TH Ave E Ste a
West Fargo, ND 58078-3328
Phone (701) 277-8844

Other practice location 1

647 13th Ave E Ste A
West Fargo, ND 58078-3328
Phone (701) 277-8844

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
I20250116001299 MN Practitioner - Mental Health Counselor 2062940174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

6600 France Ave S
Suite 425
Edina, MN 55435-1808
Phone (952) 243-8300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4763MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Jan 1, 2025 Accepting new patients
Family Support Services Inc. Mental Health PastSince Aug 28, 2022 Accepting new patients

Locations

6600 France Ave S
Ste 425
Edina, MN 55435
Phone (952) 243-8300

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1134615289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 13TH AVE E STE A",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580783328",
            "telephone_number": "701-277-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 425",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351808",
            "telephone_number": "952-243-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "647 13th Ave E Ste A",
            "address_purpose": "LOCATION",
            "city": "West Fargo",
            "state": "ND",
            "postal_code": "580783328",
            "country_code": "US",
            "telephone_number": "701-277-8844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUBALL",
        "first_name": "SARAH",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4763",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.