Jeong Eun Park, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4203 Issued in MN

Practice address

730 E 38TH St Ste 101
Minneapolis, MN 55407-5218

Phone

(612) 208-3208

NPI assigned

Jan 2, 2023

Last updated

Feb 20, 2025By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberia Joy Sherva Former name

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hyperintelligent Stoat LLC

  • Marriage & Family Therapist
  • Minneapolis, MN
  • NPI 1568267151
  NPD Authorized official

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1447963798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 E 38TH ST STE 101",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554075218",
            "telephone_number": "612-208-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 E 38TH ST STE 101",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554075218",
            "telephone_number": "612-208-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JEONG",
        "middle_name": "EUN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2023-01-02",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Breezy",
            "affiliation": "N",
            "address_1": "730 E 38th St Ste 101",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554075218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERIA",
            "last_name": "SHERVA",
            "middle_name": "JOY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Park Nicollet Clinic
• Park Nicollet Health Care Products
• Park Place Unity Clinic LLC
• Byoung Uk Park, MD
• Glennon Kyusun Park, M.D.
• June Park, PA-C
• Kaila Park, LPCC
• Katharine Sippel Park, MD
• Meeock Park, PH. D.
• Michael Chankwon Park, M.D., PH.D.

• Marriage & Family Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.