NPIMap

Organization Active NPI

Birch Lake Professional Counseling Group, Inc.

  • Professional Counselor
  • White Bear Lake, MN
National Provider Identifier
1386863793
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
00133 Issued in MN
Legal business name
BIRCH LAKE PROFESSIONAL COUNSELING GROUP, INC.
Practice address
1310 Highway 96 E
Suite 104B
White Bear Lake, MN 55110-3624
Phone
(651) 653-1925
Fax
(651) 653-1956
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Joe William Gladden II, PH.D. LPC, LMHCNPI 1639397003
Title
Managing Director
Phone
(651) 653-1925

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 00133 MN Primary

Addresses

Primary practice location

1310 Highway 96 E
Suite 104B
White Bear Lake, MN 55110-3624

Mailing address

1310 Highway 96 E
Suite 104B
White Bear Lake, MN 55110-3624
Phone (651) 653-1925

Other identifiers 1

IdentifierTypeStateIssuer
00133OtherMNLPC

National Provider Directory

National Provider Directory

Locations

1310 Highway 96 E
Ste 104B
White Bear Lake, MN 55110
Phone (651) 653-1925

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386863793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 HIGHWAY 96 E",
            "address_2": "SUITE 104B",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103624",
            "telephone_number": "651-653-1925",
            "fax_number": "651-653-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 HIGHWAY 96 E",
            "address_2": "SUITE 104B",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103624",
            "telephone_number": "651-653-1925",
            "fax_number": "651-653-1956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH LAKE PROFESSIONAL COUNSELING GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLADDEN",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "651-653-1925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "PH.D. LPC, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "00133",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.