Active NPI
Gary Goolsbee, LICSW
- Clinical Social Worker
- Forest Lake, MN
National Provider Identifier
1619990793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00593
- Practice address
- 121 11TH Ave SE
Forest Lake, MN 55025-1850 - Phone
- (651) 251-5220
- Fax
- (651) 251-5279
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 00593 | MN | Primary |
Addresses
Primary practice location
121 11TH Ave SE
Forest Lake, MN 55025-1850
Mailing address
7066 Stillwater Blvd N
Oakdale, MN 55128-3937
Phone (651) 777-5222
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17581 | Other | MN | HP |
| 5H799GO | Other | MN | BCBS |
| 105133 | Other | MN | UC |
| 62-15995 | Other | MN | UBH |
| 1004398 | Other | MN | P1 |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 593 | MN | MD | Mental Health Counselor |
| 00593 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canvas Health, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Addiction (Substance Use Disorder) Counselor
- Forest Lake, MN
- NPI 1528129574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619990793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7066 STILLWATER BLVD N",
"city": "OAKDALE",
"state": "MN",
"postal_code": "551283937",
"telephone_number": "651-777-5222",
"fax_number": "651-251-5111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 11TH AVE SE",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550251850",
"telephone_number": "651-251-5220",
"fax_number": "651-251-5279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOLSBEE",
"first_name": "GARY",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "00593",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HP",
"identifier": "17581",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "5H799GO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UC",
"identifier": "105133",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "62-15995",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P1",
"identifier": "1004398",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.