Individual provider Active NPI

Emmanuel Nwala, PHD, LPC

  • Professional Counselor
  • Saint Paul, MN
National Provider Identifier
1629386883
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4820 Issued in MN
Practice address
2136 Ford Pkwy
Saint Paul, MN 55116-2850
Phone
(605) 350-5232
NPI assigned
Sep 21, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 4820 MN Primary

Addresses

Primary practice location

2136 Ford Pkwy
Saint Paul, MN 55116-2850

Mailing address

123460 Coral Sea Street, NE
Blaine, MN 55449-6232
Phone (605) 350-5232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, IA, MN3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20250328001599 TX Practitioner - Mental Health Counselor 9335662568 Reassigns benefits to 1 organization
I20250416001588 IA Practitioner - Mental Health Counselor 9335662568 Reassigns benefits to 1 organization
I20250529001071 MN Practitioner - Mental Health Counselor 9335662568 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4820MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Reviving Therapy & Consulting LLC Professional Current Accepting new patients
Grow Healthcare Group PA Professional CurrentSince Feb 28, 2025 Accepting new patients
Breakthrough Psychological Services, LLC Professional Past Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

699 Walnut St
Ste 4
Des Moines, IA 50309
Phone (515) 278-9920

2355 Highway 36 W
Ste 400
Saint Paul, MN 55113
Phone (612) 460-1597

2136 Ford Pkwy
Saint Paul, MN 55116
Phone (605) 350-5232

700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1629386883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123460 CORAL SEA STREET, NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554496232",
            "telephone_number": "605-350-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2136 FORD PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162850",
            "telephone_number": "605-350-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWALA",
        "first_name": "EMMANUEL",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-21",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.