Amy Burkholder

Primary specialty

CounselorTaxonomy code 101Y00000X

License

178.010249 Issued in IL

Practice address

111 Hundertmark Rd Ste 205N
Chaska, MN 55318-1586

Phone

(952) 426-3856

Fax

(952) 426-3856

NPI assigned

Mar 16, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pride Counseling Services PLLCGroup PAC ID 5092100842, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pride Counseling Services PLLC

  • Community/Behavioral Health Agency
  • Mankato, MN
  • NPI 1417548587
  Medicare reassignment Care Compare group NPD
• North Counseling, LLC

  • Clinical Social Worker
  • Mankato, MN
  • NPI 1972217636
  NPD
• Collaborative Counseling LLC

  • Mental Health Counselor
  • Maple Grove, MN
  • NPI 1598034324
  NPD (past)

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1851784722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HUNDERTMARK RD STE 205N",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181586",
            "telephone_number": "952-903-1350",
            "fax_number": "952-426-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HUNDERTMARK RD STE 205N",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181586",
            "telephone_number": "952-426-3856",
            "fax_number": "952-426-3856"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17729 Kettering Trl",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550449354",
            "country_code": "US",
            "telephone_number": "612-750-2328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12918 63rd Ave N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553696001",
            "country_code": "US",
            "telephone_number": "763-210-9966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURKHOLDER",
        "first_name": "AMY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-16",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.010249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pete Brettingen, DC
• Karen Marie Brinkman, MS LP
• Jordan Alexis Brown
• Danielle Ashley Buker, M.S., CFY-SLP
• Dawn M Bunke, MA, LPCC, LADC
• Morgan Kay Butler-Fluth, LADC, LPCC
• Jennifer Caballero
• Cale Jallen Cale Jallen
• Camp Smile Orthodontics Chaska PLLC
• Camp Smile Pediatric Dentistry Chaska

• Counselor in Chaska, MN
• Providers in Chaska, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.