Active NPI
Jerome Raymond Bottelberghe, LPC
- Mental Health Counselor
- Minneota, MN
National Provider Identifier
1154953651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 01219
- Practice address
- 110 E 2ND St
Minneota, MN 56264-9639 - Phone
- (507) 530-2029
- NPI assigned
- Feb 12, 2020
- Last updated
- Feb 12, 2020
- Sex
- Male
- 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 | 01219 | MN | Primary |
Addresses
Primary practice location
110 E 2ND St
Minneota, MN 56264-9639
Mailing address
110 E 2ND St
Minneota, MN 56264-9639
Phone (507) 530-2029
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 |
|---|---|---|---|
| 01219 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581465600000",
"number": "1154953651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 E 2ND ST",
"city": "MINNEOTA",
"state": "MN",
"postal_code": "562649639",
"telephone_number": "507-530-2029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E 2ND ST",
"city": "MINNEOTA",
"state": "MN",
"postal_code": "562649639",
"telephone_number": "507-530-2029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTTELBERGHE",
"first_name": "JEROME",
"middle_name": "RAYMOND",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-12",
"last_updated": "2020-02-12",
"certification_date": "2020-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "01219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneota, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.