NPIMap

Organization Active NPI

Pride Counseling Services PLLC

  • Community/Behavioral Health Agency
  • Mankato, MN
National Provider Identifier
1417548587
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PRIDE COUNSELING SERVICES PLLC
Practice address
110 E Walnut St
Mankato, MN 56001-3655
Phone
(507) 246-2667
Fax
(507) 514-0999
NPI assigned
Feb 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Authorized official

Name
Jennifer O Kolstad, LICSWNPI 1336647106
Title
Owner
Phone
(507) 246-2667

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

110 E Walnut St
Mankato, MN 56001-3655

Mailing address

110 E Walnut St
Mankato, MN 56001-3655
Phone (507) 246-2667

Other practice location 1

1215 S Broadway St
New Ulm, MN 56073-3475
Phone (507) 246-2667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220315001315 MN Part B Supplier - Clinic/Group Practice 5092100842 Receives reassigned benefits from 5 practitioners
Practice locations: Mankato, MN

National Provider Directory

National Provider Directory

Locations

110 E Walnut St
Mankato, MN 56001
Phone (507) 246-2667

100 Warren St
Ste 324
Mankato, MN 56001
Phone (507) 246-2667

1215 S Broadway St
New Ulm, MN 56073
Phone (507) 201-4505

Practitioners & affiliated clinicians

Practitioners 9

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": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700524800000",
    "number": "1417548587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E WALNUT ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013655",
            "telephone_number": "507-246-2667",
            "fax_number": "507-514-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E WALNUT ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013655",
            "telephone_number": "507-246-2667",
            "fax_number": "507-514-0999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 S Broadway St",
            "address_purpose": "LOCATION",
            "city": "New Ulm",
            "state": "MN",
            "postal_code": "560733475",
            "country_code": "US",
            "telephone_number": "507-246-2667",
            "fax_number": "507-519-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIDE COUNSELING SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "KOLSTAD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-246-2667",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.