Great North Counseling Services, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1892 Issued in MN

Legal business name

GREAT NORTH COUNSELING SERVICES, LLC

Practice address

310 4TH Ave S
Ste 5010 PMB 91823
Minneapolis, MN 55415-1053

Phone

(218) 214-6096

Fax

(888) 972-3614

NPI assigned

Nov 4, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Kimberly Carroll, LADC, LPCC

Title

Business Owner, Primary Clinician

Phone

(218) 214-6096

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1538601778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 4TH AVE S",
            "address_2": "STE 5010 PMB 91823",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151053",
            "telephone_number": "218-214-6096",
            "fax_number": "888-972-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 4TH AVE S",
            "address_2": "STE 5010 PMB 91823",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151053",
            "telephone_number": "218-214-6096",
            "fax_number": "888-972-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT NORTH COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "BUSINESS OWNER, PRIMARY CLINICIAN",
        "authorized_official_telephone_number": "218-214-6096",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LADC, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304598",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "1892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Minneapolis, MN
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• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.