Vitaly Ana Sukochev, M.A.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2047 Issued in MN

Practice address

1385 Mendota Heights Rd Ste 200
Mendota Heights, MN 55120

Phone

(651) 379-9800

Fax

(651) 405-0358

NPI assigned

May 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Vitaliy Anatolyevich Sukochev Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

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.

• Family Adolescents and Children Therapy Services Inc.

  • Community/Behavioral Health Agency
  • Eagan, MN
  • NPI 1518053834
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1174730840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 MENDOTA HEIGHTS RD STE 200",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "55120",
            "telephone_number": "651-379-9800",
            "fax_number": "651-405-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 MENDOTA HEIGHTS RD STE 200",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "55120",
            "telephone_number": "651-379-9800",
            "fax_number": "651-405-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKOCHEV",
        "first_name": "VITALY",
        "middle_name": "ANA",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VITALIY",
            "last_name": "SUKOCHEV",
            "middle_name": "ANATOLYEVICH",
            "credential": "SOCIAL SCIENCE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Darilyn Joyce Stillday
• Jessica Rae Stock, LADC
• Heidi Stromberg, M.ED.
• Laura Abigail Suflita
• Abdirahman Sugulle
• Ingrid Sulistyo
• Camilla Zulieka Sumrall
• Dorothy Swanson
• Justin W Swanson, LICSW
• Thaine Swirtz

• Marriage & Family Therapist in Mendota Heights, MN
• Providers in Mendota Heights, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.

Verify at the official NPI Registry.