Individual provider Active NPI

Philip Caleb Zastrow, LPCC

  • Professional Counselor
  • Woodbury, MN
National Provider Identifier
1255968111
Registry record updated Mar 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC02402 Issued in MN
Practice address
1811 Weir Dr Ste 270
Woodbury, MN 55125-6741
Phone
(651) 714-9646
NPI assigned
Mar 23, 2020
Last updated
Mar 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC02402 MN Primary

Addresses

Primary practice location

1811 Weir Dr Ste 270
Woodbury, MN 55125-6741

Mailing address

1811 Weir Dr Ste 270
Woodbury, MN 55125-6741
Phone (651) 714-9646

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240416003615 MN Practitioner - Mental Health Counselor 9436598992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

1811 Weir Dr
Suite 270
Woodbury, MN 55125-6741
Phone 6517149646651714

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC02402MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Mar 3, 2024 Accepting new patients
Family Support Services Inc. CurrentSince Mar 3, 2024 Accepting new patients

Locations

7300 147th St W
Ste 600
Apple Valley, MN 55124
Phone (952) 997-3020

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

1811 Weir Dr
Ste 270
Woodbury, MN 55125
Phone (651) 243-6087

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1255968111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 WEIR DR STE 270",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551256741",
            "telephone_number": "651-714-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 WEIR DR STE 270",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551256741",
            "telephone_number": "651-714-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZASTROW",
        "first_name": "PHILIP",
        "middle_name": "CALEB",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC02402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.