Individual provider Active NPI

Nohemi Enna Weekley

  • Marriage & Family Therapist
  • Coon Rapids, MN
National Provider Identifier
1720477300
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2833 Issued in MN
Practice address
199 Coon Rapids Blvd NW Ste 306
Coon Rapids, MN 55433-5861
Phone
(763) 780-1520
Fax
(763) 780-2114
NPI assigned
Jan 20, 2015
Last updated
Apr 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 2833 MN Primary

Addresses

Primary practice location

199 Coon Rapids Blvd NW Ste 306
Coon Rapids, MN 55433-5861

Mailing address

11170 68TH St NE
Albertville, MN 55301-4582
Phone (763) 780-1520

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
I20240201001409 MN Practitioner - Marriage and Family Therapist 6800249251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Based Therapy AssociatesGroup PAC ID 2264432681, 12 clinicians

Practice addresses (Care Compare)

199 Coon Rapids Blvd NW
Suite 306
Coon Rapids, MN 55433-5861
Phone (763) 780-1520

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2833MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Based Therapy Associates CurrentSince Jan 1, 2024 Accepting new patients
Family Based Therapy Associates PastSince May 3, 2020 Accepting new patients

Locations

199 Coon Rapids Blvd NW
Ste 306
Minneapolis, MN 55433
Phone (763) 780-1520

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1720477300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11170 68TH ST NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "553014582",
            "telephone_number": "763-780-1520",
            "fax_number": "763-780-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 COON RAPIDS BLVD NW STE 306",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335861",
            "telephone_number": "763-780-1520",
            "fax_number": "763-780-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEEKLEY",
        "first_name": "NOHEMI",
        "middle_name": "ENNA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.