NPIMap

Organization Active NPI

Introspect Mental Health LLC

  • Mental Health Counselor
  • White Bear LK, MN
National Provider Identifier
1184273666
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INTROSPECT MENTAL HEALTH LLC
Practice address
4801 Highway 61 N Ste 204
White Bear LK, MN 55110-2752
Phone
(763) 465-6700
NPI assigned
Sep 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Samantha Yerks, LICSW LADCNPI 1336374750
Title
Owner
Phone
(651) 271-8970

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4801 Highway 61 N Ste 204
White Bear LK, MN 55110-2752

Mailing address

22130 Typo Creek Dr NE
Wyoming, MN 55092-4602
Phone (651) 271-8970

Other practice location 1

144 2nd Ave SE
Cambridge, MN 55008-1601
Phone (763) 465-6700

Other practice location 2

301 Village Pkwy
Circle Pines, MN 55014-5008
Phone (763) 465-6700

Other practice location 3

4801 Highway 61 N Ste 204
White Bear Lk, MN 55110-2752
Phone (763) 465-6700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210730002128 MN Part B Supplier - Clinic/Group Practice 9931502796 Receives reassigned benefits from 8 practitioners
Practice locations: Cambridge, MN; White Bear LK, MN; Circle Pines, MN

National Provider Directory

National Provider Directory

Locations

144 2nd Ave SE
Cambridge, MN 55008
Phone (763) 465-0720

4801 Highway 61 N
Ste 204
White Bear Lk, MN 55110
Phone (763) 465-6700

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1567900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1184273666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22130 TYPO CREEK DR NE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550924602",
            "telephone_number": "651-271-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N STE 204",
            "city": "WHITE BEAR LK",
            "state": "MN",
            "postal_code": "551102752",
            "telephone_number": "763-465-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "144 2nd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MN",
            "postal_code": "550081601",
            "country_code": "US",
            "telephone_number": "763-465-6700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 Village Pkwy",
            "address_purpose": "LOCATION",
            "city": "Circle Pines",
            "state": "MN",
            "postal_code": "550145008",
            "country_code": "US",
            "telephone_number": "763-465-6700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4801 Highway 61 N Ste 204",
            "address_purpose": "LOCATION",
            "city": "White Bear Lk",
            "state": "MN",
            "postal_code": "551102752",
            "country_code": "US",
            "telephone_number": "763-465-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTROSPECT MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-08",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "YERKS",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-271-8970",
        "authorized_official_credential": "LICSW LADC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear LK, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.