Carolyn Ann K. Walker

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2613 Issued in MN

Practice address

570 Professional Dr
Northfield, MN 55057-2756

Phone

(507) 301-3412

Fax

(507) 301-3308

NPI assigned

Nov 29, 2020

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

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

Group practices

Secure Base Counseling Center LLCGroup PAC ID 8628409299, 22 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 and National Provider Directory roles.

• Secure Base Counseling Center LLC

  • Psychologist
  • Northfield, MN
  • NPI 1285905885
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1606608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606608000000",
    "number": "1235733460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572756",
            "telephone_number": "507-301-3412",
            "fax_number": "507-301-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572756",
            "telephone_number": "507-301-3412",
            "fax_number": "507-301-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "CAROLYN",
        "middle_name": "ANN K.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-29",
        "last_updated": "2020-11-29",
        "certification_date": "2020-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "2613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@securebasecounselingcenter.com",
            "affiliation": "N",
            "address_1": "570 Professional Dr",
            "city": "Northfield",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550572756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eddie Viola, R.N.
• Vivie Senior Living of Northfield LLC
• William R Votel, MD
• Ngoc Bich Vu, MD
• Walgreen Co
• Jennifer Marie Wallin, CMT
• Jon E Walser-Kuntz, LP
• Lori Kay Warner, OTR
• David H Watkins, PT
• Madison Weber, RBT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2020; 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.