Jin Park, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4343 Issued in MN

Practice address

2984 Rice St
Little Canada, MN 55113-2230

Phone

(651) 968-4974

NPI assigned

Apr 3, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• North Star Mental Health, LLC

  • Clinical Psychologist
  • Little Canada, MN
  • NPI 1316286974
  NPD
• Park Therapy & Wellness, LLC

  • Professional Counselor
  • Bloomington, MN
  • NPI 1942175898

  Professional

  NPD

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1225880388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 W 98TH ST # 2115",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554372040",
            "telephone_number": "612-405-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2984 RICE ST",
            "city": "LITTLE CANADA",
            "state": "MN",
            "postal_code": "551132230",
            "telephone_number": "651-968-4974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JIN",
        "name_prefix": "Mrs.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-03",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northeast Residence, Inc.
• Clara Olson, SLP-CCC
• Lindsie Olson, DC
• Kayla Oswald
• Paragon Health
• Peak Behavioral Health, LLC
• Porsche Peak, LMFT, LADC
• Julie L Peot, D.C.
• Ondrea Perlman, CNM
• Andrew Robert Peterson, MSW, LICSW

• Professional Counselor in Little Canada, MN
• Providers in Little Canada, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.