Active NPI
Tyler Bennett
- Professional Counselor
- Windom, MN
National Provider Identifier
1649794637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC01570
- Practice address
- 41385 US Highway 71
Windom, MN 56101-3197 - Phone
- (507) 831-2090
- NPI assigned
- Aug 1, 2017
- Last updated
- Mar 17, 2018
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC01570 | MN | Primary |
Addresses
Primary practice location
41385 US Highway 71
Windom, MN 56101-3197
Mailing address
PO Box 353
Windom, MN 56101-0353
Other practice location 1
401 West St Ste 117
Jackson, MN 56143-1219
Phone (507) 847-2423
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 |
|---|---|---|---|
| CC01570 | MN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwestern Mental Health Center 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Luverne, MN
- NPI 1487654562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1649794637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 353",
"city": "WINDOM",
"state": "MN",
"postal_code": "561010353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41385 US HIGHWAY 71",
"city": "WINDOM",
"state": "MN",
"postal_code": "561013197",
"telephone_number": "507-831-2090"
}
],
"practiceLocations": [
{
"address_1": "401 West St Ste 117",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MN",
"postal_code": "561431219",
"country_code": "US",
"telephone_number": "507-847-2423",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BENNETT",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-01",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "CC01570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windom, MN
- Avera Marshall (Avera Medical Group Optometry Windom)
- Avera McKennan (Avera Medical Group Optometry Windom)
- Avera McKennan (Avera Medical Group Windom)
- Barbara Jo Bennett, MMT, MT-BC
- Stanley Harold Bennett, MD
- Mitchel Erickson Boeck, DPT
- Tabitha Nyaboke Bosire, CNP
- Karen Lee Brinkman, MS, LP, LPCC
- Stephanie C Buhler, M.D.
- Yvonne M. Callaghan, LMFT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.