Individual provider Active NPI

Linda Elaine Anderson, CLINICAL TRAINEE

  • Mental Health Counselor
  • Grand Rapids, MN
National Provider Identifier
1699366799
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
516 S Pokegama Ave
Grand Rapids, MN 55744-3800
Phone
(612) 964-1724
NPI assigned
Feb 1, 2021
Last updated
Feb 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 1

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

Addresses

Primary practice location

516 S Pokegama Ave
Grand Rapids, MN 55744-3800

Mailing address

516 S Pokegama Ave
Grand Rapids, MN 55744-3800
Phone (612) 964-1724

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL procentive

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240520001625 MN Practitioner - Mental Health Counselor 7810339009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3952MNMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1699366799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 S POKEGAMA AVE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443800",
            "telephone_number": "612-964-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 S POKEGAMA AVE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443800",
            "telephone_number": "612-964-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "LINDA",
        "middle_name": "ELAINE",
        "credential": "CLINICAL TRAINEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "procentive",
            "affiliation": "N",
            "endpointDescription": "procentive",
            "address_1": "516 S Pokegama Ave",
            "city": "Grand Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557443800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.