779 Riverside Recovery & Counseling Services

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

303344 Issued in MN

Legal business name

779 RIVERSIDE RECOVERY & COUNSELING SERVICES

Practice address

4940 W 77TH St
Edina, MN 55435-4805

Phone

(612) 223-6622

NPI assigned

Jul 25, 2018

Last updated

Jul 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Coach Nakumbe, LPCC, LADC

Title

Owner / Clinical Director

Phone

(612) 223-6622

Specialties & licenses 9

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Uknown Nakumbe, LPCC, LADC

  • Mental Health Counselor
  • Edina, MN
  • NPI 1225570740

  Addiction (Substance Use Disorder)

  NPD

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1437636131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8014 HIGHWAY 55 UNIT 197",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274712",
            "telephone_number": "612-223-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 W 77TH ST",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354805",
            "telephone_number": "612-223-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "779 RIVERSIDE RECOVERY & COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "NAKUMBE",
        "authorized_official_first_name": "COACH",
        "authorized_official_title_or_position": "OWNER / CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "612-223-6622",
        "authorized_official_credential": "LPCC, LADC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303344",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "00935",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "00935",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Edina, MN
• Providers in Edina, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; 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.