Brent D Debruyn, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3669 Issued in MN

Practice address

1714 Bunker Lake Blvd NW Ste 100
Andover, MN 55304-4091

Phone

(763) 330-2830

Fax

(763) 330-2831

NPI assigned

Sep 23, 2022

Last updated

Apr 7, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment Care Compare group NPD
• Lee Carlson Center for Mental Health and Well-Being

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fridley, MN
  • NPI 1457455057
  NPD

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1467175505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 BUNKER LAKE BLVD NW STE 100",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553044091",
            "telephone_number": "763-330-2830",
            "fax_number": "763-330-2831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7954 University Ave NE",
            "address_purpose": "LOCATION",
            "city": "Fridley",
            "state": "MN",
            "postal_code": "554321860",
            "country_code": "US",
            "telephone_number": "763-780-3036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEBRUYN",
        "first_name": "BRENT",
        "middle_name": "D",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-23",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "3669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Andria Davis, OTR/L
• Maria Faye Davis, MAOT GRAD
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• Raina Demarais, OTR/L
• Don Curtis Deno, M.D.

• Professional Counselor in Andover, MN
• Providers in Andover, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.