Community Outreach Counseling PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1071 Issued in MN

Legal business name

COMMUNITY OUTREACH COUNSELING PC

Practice address

1617 Highway 12 E
Suite 230
Willmar, MN 56201-5814

Phone

(320) 905-0795

Fax

(320) 205-0030

NPI assigned

Apr 8, 2013

Last updated

Sep 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Timothy R Johnson, MA LMFTNPI 1699864660

Title

Owner

Phone

(320) 905-0795

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Roger Johnson, MA LMFT

  • Marriage & Family Therapist
  • Willmar, MN
  • NPI 1699864660
  Medicare reassignment Care Compare group NPD Authorized official
• Alisa R Johnson, LPCC

  • Professional Counselor
  • Willmar, MN
  • NPI 1598475212
  Medicare reassignment Care Compare group NPD
• Kelly Marie Kveene, L.M.F.T.

  • Marriage & Family Therapist
  • Willmar, MN
  • NPI 1922326412
  NPD (past)
• Kristy Nystrom, LMFT

  • Marriage & Family Therapist
  • Willmar, MN
  • NPI 1508261157
  NPD (past)

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1245673482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 HIGHWAY 12 E",
            "address_2": "SUITE 230",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015814",
            "telephone_number": "320-905-0795",
            "fax_number": "320-205-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 HIGHWAY 12 E",
            "address_2": "SUITE 230",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015814",
            "telephone_number": "320-905-0795",
            "fax_number": "320-205-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OUTREACH COUNSELING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-08",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-905-0795",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168211300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irma J Cockerill, MD
• Mary Jo Cody, MSW/LICSW
• Community Addiction Recovery Enterprise (Community Addiction Recovery Enterprise Detention Center)
• Community Behavioral Health Hospital-Willmar (CBHH-Willmar)
• Community Health Service Inc.
• Compass Chiropractic LLC (Compass Chiropractic)
• Compassionate Cottage, LLC.
• Jaclynn N Condon
• Cornerstone of Willmar, Inc.
• Lorinda Jean Coudron, RN CNP

• Community/Behavioral Health Agency in Willmar, MN
• Providers in Willmar, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.