Individual provider Active NPI

Valissa Milanovich, LMFT

  • Marriage & Family Therapist
  • Coon Rapids, MN
National Provider Identifier
1215319504
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2608 Issued in MN
Practice address
3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599
Phone
(763) 767-3350
Fax
(763) 767-0912
NPI assigned
Jun 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 2608 MN Primary

Addresses

Primary practice location

3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599

Mailing address

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Phone (651) 379-1718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231222002521 MN Practitioner - Marriage and Family Therapist 1456701002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Phone (763) 767-3350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2608MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Marriage & Family Therapist CurrentSince Jan 1, 2024 Accepting new patients

Locations

11660 Round Lake Blvd NW
Coon Rapids, MN 55433
Phone (763) 317-0718

3833 Coon Rapids Blvd NW
Ste 120
Minneapolis, MN 55433
Phone (763) 433-2000

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

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.

NPI Registry JSON

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1215319504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "address_2": "SUITE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-379-1718",
            "fax_number": "651-379-1738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332599",
            "telephone_number": "763-767-3350",
            "fax_number": "763-767-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILANOVICH",
        "first_name": "VALISSA",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-23",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.