NPIMap

Organization Active NPI

Collaborative Counseling LLC

  • Mental Health Counselor
  • Maple Grove, MN
National Provider Identifier
1598034324
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1064 Issued in MN
Legal business name
COLLABORATIVE COUNSELING LLC
Practice address
12918 63Rd Ave N
Maple Grove, MN 55369-6001
Phone
(763) 210-9966
NPI assigned
Dec 22, 2011
Last updated
May 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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

Authorized official

Name
Naomi Doriott Larson, MA, LPC, LPCCNPI 1609005636
Title
Owner and Therapist
Phone
(763) 210-9966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 1064 MN Primary

Addresses

Primary practice location

12918 63Rd Ave N
Maple Grove, MN 55369-6001

Mailing address

12918 63Rd Ave N
Maple Grove, MN 55369-6001
Phone (763) 210-9966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160907001302 WI Part B Supplier - Clinic/Group Practice 3678711900 Receives reassigned benefits from 27 practitioners
Practice locations: Eau Claire, WI; Maple Grove, MN; Hudson, WI
O20160909002528 MN Part B Supplier - Clinic/Group Practice 3678711900 Receives reassigned benefits from 44 practitioners
Practice locations: Chanhassen, MN; Lakeville, MN; Maple Grove, MN; Northfield, MN; Roseville, MN

National Provider Directory

National Provider Directory

Locations

7925 Stone Creek Dr
Ste 120
Chanhassen, MN 55317

10621 165th St W
Lakeville, MN 55044
Phone (320) 491-4589

12918 63rd Ave N
Maple Grove, MN 55369
Phone (763) 210-9983

7201 Forestview Ln N
Lowr
Maple Grove, MN 55369

411 Water St S
Ste 4
Northfield, MN 55057

1935 County Road B2 W
Ste 145
Roseville, MN 55113

2277 Highway 36 W
Ste 255
Roseville, MN 55113

2115 E Clairemont Ave
Ste 2
Eau Claire, WI 54701
Phone (507) 993-0437

3610 Oakwood Mall Dr
Ste 104
Eau Claire, WI 54701
Phone (815) 210-8739

3610 Oakwood Mall Dr
Ste 203
Eau Claire, WI 54701

901 4th St
Hudson, WI 54016
Phone (651) 492-8498

Practitioners & affiliated clinicians

Practitioners 88

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.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1598034324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12918 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696001",
            "telephone_number": "763-210-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12918 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696001",
            "telephone_number": "763-210-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "DORIOTT LARSON",
        "authorized_official_first_name": "NAOMI",
        "authorized_official_title_or_position": "OWNER AND THERAPIST",
        "authorized_official_telephone_number": "763-210-9966",
        "authorized_official_credential": "MA, LPC, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "1064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.