Active NPI
Regina R Mulder, LPCC
- Professional Counselor
- Red Wing, MN
National Provider Identifier
1144506213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC 4631
- Practice address
- 124 Tyler Rd S
Red Wing, MN 55066-1733 - Phone
- (651) 977-5001
- NPI assigned
- Nov 2, 2011
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC 4631 | ID | Primary |
Addresses
Primary practice location
124 Tyler Rd S
Red Wing, MN 55066-1733
Mailing address
1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
Phone (651) 628-9566
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 |
|---|---|---|---|
| LPC 4631 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nystrom & Associates, LTD | Current | Accepting new patients |
Locations
124 Tyler Rd S
Red Wing, MN 55066
Phone (651) 977-5001
1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704
Organizations & group practices 1
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.
-
dba Sagent Behavioral Health
- Clinical Social Worker
- New Brighton, MN
- NPI 1396750188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1144506213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121786",
"telephone_number": "651-628-9566",
"fax_number": "651-628-0411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 TYLER RD S",
"city": "RED WING",
"state": "MN",
"postal_code": "550661733",
"telephone_number": "651-977-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULDER",
"first_name": "REGINA",
"middle_name": "R",
"credential": "LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2023-07-05",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC 4631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Wing, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.