Individual provider Active NPI

Tara Lujuan Floersch, LICSW

  • Clinical Social Worker
  • New Brighton, MN
National Provider Identifier
1790460186
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
30069 Issued in MN
Practice address
900 Long Lake Rd Ste 215
New Brighton, MN 55112-6428
Phone
(612) 900-0233
NPI assigned
Jun 21, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 30069 MN Primary

Addresses

Primary practice location

900 Long Lake Rd Ste 215
New Brighton, MN 55112-6428

Mailing address

1621 Highway 96 E
White Bear Lake, MN 55110-7622
Phone (218) 205-1369

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
I20231018000581 MN Practitioner - Clinical Social Worker 4183079692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Conscious Healing Counseling IncGroup PAC ID 4688095268, 16 clinicians

Practice addresses (Care Compare)

2705 Bunker Lake Blvd NW
Suite 112
Andover, MN 55304-3785
Phone (612) 900-0233

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30069MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conscious Healing Counseling Inc CurrentSince Aug 6, 2023 Accepting new patients

Locations

2705 Bunker Lake Blvd NW
Ste 112
Andover, MN 55304
Phone (612) 900-0233

900 Long Lake Rd
Ste 215
New Brighton, MN 55112
Phone (612) 900-0233

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": "1687305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1790460186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 HIGHWAY 96 E",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551107622",
            "telephone_number": "218-205-1369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD STE 215",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126428",
            "telephone_number": "612-900-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLOERSCH",
        "first_name": "TARA",
        "middle_name": "LUJUAN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brighton, MN

Sources for this page

Verify at the official NPI Registry.