Active NPI
Grant Dietrich, LPCC, LADC
- Mental Health Counselor
- Brooklyn Center, MN
National Provider Identifier
1750018644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CC00991
- Practice address
- 6040 Earle Brown Dr Ste 100
Brooklyn Center, MN 55430-2561 - Phone
- (651) 313-8080
- NPI assigned
- Aug 2, 2022
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CC00991 | MN | Primary |
Addresses
Primary practice location
6040 Earle Brown Dr Ste 100
Brooklyn Center, MN 55430-2561
Mailing address
3189 Countryside Ave Unit F
Woodbury, MN 55129-7837
Phone (651) 746-9131
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 |
|---|---|---|---|
| CC00991 | MN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nystrom & Associates, LTD | Current | Accepting new patients | |
| Ellie Family Services, PLLP | Current | Accepting new patients |
Locations
6040 Earle Brown Dr
Ste 100
Minneapolis, MN 55430
Phone (612) 470-4576
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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Mendota Heights, MN
- NPI 1740664150
-
- Clinical Social Worker
- New Brighton, MN
- NPI 1396750188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1659398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659398400000",
"number": "1750018644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3189 COUNTRYSIDE AVE UNIT F",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551297837",
"telephone_number": "651-746-9131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6040 EARLE BROWN DR STE 100",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302561",
"telephone_number": "651-313-8080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "GRANT",
"credential": "LPCC, LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-02",
"last_updated": "2022-08-02",
"certification_date": "2022-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "CC00991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.