Individual provider Active NPI

Amanda Schmidt, LPCC, LADC

  • Mental Health Counselor
  • Andover, MN
National Provider Identifier
1366079014
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
02044 Issued in MN
Practice address
1875 Station Pkwy NW
Andover, MN 55304-3319
Phone
(763) 482-9598
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 305542 MN
Mental Health Counselor 101YM0800X 02044 MN Primary

Addresses

Primary practice location

1875 Station Pkwy NW
Andover, MN 55304-3319

Mailing address

1875 Station Pkwy NW
Andover, MN 55304-3319
Phone (763) 482-9598

Other names 1

  • Amanda Stebor Former name

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
I20240103002526 MN Practitioner - Mental Health Counselor 0244680213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rum River Counseling, IncGroup PAC ID 0941661482, 20 clinicians

Practice addresses (Care Compare)

1875 Station Pkwy NW
Andover, MN 55304-4259
Phone (763) 482-9598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
305542MNMDAddiction (Substance Use Disorder) Counselor
02044MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Rum River Counseling, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Family Support Services Inc. Mental Health PastSince Nov 1, 2020 Accepting new patients

Locations

1875 Station Pkwy NW
Andover, MN 55304

7200 Hudson Blvd N
Ste 220
Oakdale, MN 55128

18205 45th Ave N
Ste D
Plymouth, MN 55446
Phone (214) 554-4089

14115 James Rd
Ste 305
Rogers, MN 55374
Phone (763) 575-8086

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1366079014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDT",
        "first_name": "AMANDA",
        "credential": "LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305542",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "02044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "STEBOR",
            "credential": "LPCC, LADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Andover, MN

Sources for this page

Verify at the official NPI Registry.