NPIMap

Organization Active NPI

North Central Ministry Development Center, Inc.

Doing business as LeaderWise Counseling

  • Counseling Psychologist
  • New Brighton, MN
National Provider Identifier
1164711735
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
LP4114 Issued in MN
Legal business name
NORTH CENTRAL MINISTRY DEVELOPMENT CENTER, INC.
Doing business as
LeaderWise Counseling
Practice address
516 Mission House LN
New Brighton, MN 55112-2571
Phone
(651) 636-5120
Fax
(651) 636-5124
NPI assigned
Apr 4, 2011
Last updated
May 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

Name
Mark Elmer Sundby, PH.D.NPI 1710278502
Title
Executive Director
Phone
(651) 636-5120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4223 MN
Counseling Psychologist 103TC1900X LP4114 MN Primary
Counseling Psychologist 103TC1900X LP0816 MN
Counseling Psychologist 103TC1900X LP5213 MN
Clinical Social Worker 1041C0700X MN06627 MN

Addresses

Primary practice location

516 Mission House LN
New Brighton, MN 55112-2571

Mailing address

516 Mission House LN
New Brighton, MN 55112-2571
Phone (651) 636-5120

Other names 1

  • LeaderWise Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210503000006 MN Part B Supplier - Clinic/Group Practice 7214346345 Receives reassigned benefits from 11 practitioners
Practice locations: New Brighton, MN

National Provider Directory

National Provider Directory

Locations

6122 42nd Ave N
Crystal, MN 55422
Phone (651) 636-5120

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1164711735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 MISSION HOUSE LN",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122571",
            "telephone_number": "651-636-5120",
            "fax_number": "651-636-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MISSION HOUSE LN",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551122571",
            "telephone_number": "651-636-5120",
            "fax_number": "651-636-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CENTRAL MINISTRY DEVELOPMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "SUNDBY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ELMER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-636-5120",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4223",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP4114",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP0816",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP5213",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "MN06627",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LeaderWise Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Brighton, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.