Kathleen Jo Penn, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC04005 Issued in MN

Practice address

4710 White Bear Pkwy
White Bear Lake, MN 55110-3485

Phone

(651) 443-9290

NPI assigned

Mar 22, 2024

Last updated

Mar 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Applied Care Services IncGroup PAC ID 2769978212, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Applied Care Services, Inc.

  • Community/Behavioral Health Agency
  • Richfield, MN
  • NPI 1932475647
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1215787338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5625 138TH ST N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550388200",
            "telephone_number": "651-387-6244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103485",
            "telephone_number": "651-443-9290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5625 138th St N",
            "address_purpose": "LOCATION",
            "city": "Hugo",
            "state": "MN",
            "postal_code": "550388200",
            "country_code": "US",
            "telephone_number": "651-387-6244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENN",
        "first_name": "KATHLEEN",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC04005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ty Evan Paulick, D.C.
• Peace of Mind Home Care, LLC
• Peddycoart Chiropractic Inc.
• Brenwyn Anne Lisa Peddycoart, DC
• Teresa A Pena, MD
• Anna Lee Percival, OD
• Jessica Walker Perkins
• Danielle R Perry Ramirez, MD
• David Michael Perry, O.D.
• Christopher M Phillips, DPM.

• Mental Health Counselor in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.