Raven Indigo Winter, MA, LPCC, CCTP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1759 Issued in MN

Practice address

21395 John Milless Dr Ste 400
Rogers, MN 55374-4407

Phone

(763) 424-1888

Fax

(763) 424-7288

NPI assigned

Nov 21, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Shannon R Nelson Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Northwinds Counseling Services, P.a.

  • Marriage & Family Therapist
  • Rogers, MN
  • NPI 1760562540
  Medicare reassignment NPD

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1225435050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 MEADOW OAK AVE APT 241",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553622612",
            "telephone_number": "637-639-9801",
            "fax_number": "763-657-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21395 JOHN MILLESS DR STE 400",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553744407",
            "telephone_number": "763-424-1888",
            "fax_number": "763-424-7288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINTER",
        "first_name": "RAVEN",
        "middle_name": "INDIGO",
        "credential": "MA, LPCC, CCTP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-21",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "1759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "NELSON",
            "middle_name": "R",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wellnest Homecare Services LLC
• Alexandra Elizabeth Wells, MD
• Ali Margaret Wells, CNP
• Westpacific Westpac Anesthesia-Anesthesia Consultants of Minnesot
• Alexi Elaine Wiessinger
• Tammy Lynn Woodward, LPN
• Cheri Wyman, RPH
• Lynn M Youngner, PA-C
• Christopher Louis Zacharias, D.D.S.
• Jiaming Zhang

• Mental Health Counselor in Rogers, MN
• Providers in Rogers, 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 Oct 14, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.