Individual provider Active NPI

Nicole White, MA, LPCC

  • Professional Counselor
  • Fridley, MN
National Provider Identifier
1346677937
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC00606 Issued in MN
Practice address
550 Osborne Rd NE
Fridley, MN 55432-2718
Phone
(763) 236-5950
NPI assigned
Sep 27, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

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 CC00606 MN Primary

Addresses

Primary practice location

550 Osborne Rd NE
Fridley, MN 55432-2718

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000

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
I20240214001448 MN Practitioner - Mental Health Counselor 7214385962 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

6341 University Ave NE
Fridley, MN 55432-4946
Phone (763) 572-5700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
CC00606MNMDProfessional Counselor
606MNMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Jan 1, 2024 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jan 1, 2024 Accepting new patients
Fairview Health Services CurrentSince Jan 1, 2024 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Jan 1, 2024 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2024 Accepting new patients
Fairview Health Services CurrentSince Jan 1, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients

Locations

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489363200000",
    "number": "1346677937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "NICOLE",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-27",
        "last_updated": "2017-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.