Individual provider Active NPI

Catherine Nicole Breuer Johnson, LPCC

  • Mental Health Counselor
  • Maple Grove, MN
National Provider Identifier
1710435623
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CC01097 Issued in MN
Practice address
12918 63Rd Ave N
Maple Grove, MN 55369-6001
Phone
(763) 210-9966
NPI assigned
Sep 20, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

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 CC01097 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 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
I20240117000567 MN Practitioner - Mental Health Counselor 1254783194 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC01097MNMDMental Health Counselor
1097MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Collaborative Counseling LLC Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

12918 63rd Ave N
Maple Grove, MN 55369
Phone (952) 999-1959

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.

NPI Registry JSON

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

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1710435623",
    "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": {
        "last_name": "JOHNSON",
        "first_name": "CATHERINE",
        "middle_name": "NICOLE BREUER",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-20",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC01097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.