Kristine Lee Edstrom, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2875 Issued in MN

Practice address

504 S 2ND Ave
Virginia, MN 55792

Phone

(218) 212-5700

NPI assigned

Oct 2, 2019

Last updated

May 31, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Mindfully Blessed LLC

  • Community/Behavioral Health Agency
  • Biwabik, MN
  • NPI 1609514918
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1225679053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "BIWABIK",
            "state": "MN",
            "postal_code": "557080498",
            "telephone_number": "218-591-6023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S 2ND AVE",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "55792",
            "telephone_number": "218-212-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSTROM",
        "first_name": "KRISTINE",
        "middle_name": "LEE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "2875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BOARD OF BEHAVIORAL HEALTH AND THERAPY",
            "identifier": "2875",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Practicefusion",
            "affiliation": "Y",
            "affiliationName": "EUSTICE COUNSELING LLC",
            "address_1": "302 E Howard St",
            "city": "Hibbing",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557461772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordyn Renee Drees
• Maegan Joanne Duchene
• Theresa Marie Duffy, CRNA
• Edgewood Virginia I Senior Living LLC
• Edgewood Virginia Senior Living LLC
• Nancy Eichholz, RN, CNP
• Vanessa A Eichorn
• Christian Eikam
• Rachel Anne Eisenhuth, PT
• Mohamed Elhabit

• Professional Counselor in Virginia, MN
• Providers in Virginia, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.