Active NPI
Deborah C Haddock, LP, LPC
- Professional Counselor
- Edina, MN
National Provider Identifier
1497824486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC00151
- Practice address
- 4005 W 65TH St
Suite 214
Edina, MN 55435-1720 - Phone
- (612) 940-0653
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC00151 | MN | Primary |
| Counseling Psychologist | 103TC1900X | LP3466 | MN |
Addresses
Primary practice location
4005 W 65TH St
Suite 214
Edina, MN 55435-1720
Mailing address
4005 W 65TH St
Suite 214
Edina, MN 55435-1720
Phone (612) 940-0653
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84905701132 | Other | MN | PREFERRED ONE ID |
| 01H70HA | Other | MN | BCBS ID |
| 62-90979 | Other | MN | MEDICA ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC00151 | MN | MD | Professional Counselor |
| LP3466 | MN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1497824486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 214",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "612-940-0653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 214",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "612-940-0653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOCK",
"first_name": "DEBORAH",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "LP, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "LPC00151",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP3466",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE ID",
"identifier": "84905701132",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID",
"identifier": "01H70HA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA ID",
"identifier": "62-90979",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.