Individual provider Active NPI

Jenna Hertaus, LPCC

  • Mental Health Counselor
  • Roseville, MN
National Provider Identifier
1295349678
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2595 Issued in MN
Practice address
2990 Centre Pointe Dr
Roseville, MN 55113-1182
Phone
(651) 638-1560
NPI assigned
Sep 3, 2020
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2595 MN Primary

Addresses

Primary practice location

2990 Centre Pointe Dr
Roseville, MN 55113-1182

Mailing address

2990 Centre Pointe Dr
Roseville, MN 55113-1182
Phone (651) 638-1560

Other practice location 1

12574 Foxhill Ave N
Hugo, MN 55038-7544
Phone (320) 291-9153

Other practice location 2

12574 Foxhill Ave N
Hugo, MN 55038-7544
Phone (320) 291-9153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2595MNMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Roots Therapy, LLC Current Accepting new patients
Prairiecare LLC PastSince Sep 1, 2020 Accepting new patients
Childrens Health Care PastSince Dec 10, 2023 Accepting new patients
St. Croix Psychiatric, LLC Mental Health PastSince Sep 1, 2020 Accepting new patients

Locations

4707 Highway 61 N
White Bear Lake, MN 55110
Phone (612) 567-6306

Organizations & group practices 4

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": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1295349678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 CENTRE POINTE DR",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131182",
            "telephone_number": "651-638-1560",
            "fax_number": "952-992-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 CENTRE POINTE DR",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131182",
            "telephone_number": "651-638-1560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12574 Foxhill Ave N",
            "address_purpose": "LOCATION",
            "city": "Hugo",
            "state": "MN",
            "postal_code": "550387544",
            "country_code": "US",
            "telephone_number": "320-291-9153",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12574 Foxhill Ave N",
            "address_purpose": "LOCATION",
            "city": "Hugo",
            "state": "MN",
            "postal_code": "550387544",
            "country_code": "US",
            "telephone_number": "320-291-9153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERTAUS",
        "first_name": "JENNA",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.