Amanda Vestal, LPCC, LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC04032 Issued in MN

Practice address

299 Coon Rapids Blvd NW Ste 100
Coon Rapids, MN 55433-5869

Phone

(651) 240-2206

Fax

(612) 466-5677

NPI assigned

Jul 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Vayda Mental Health Collaborative PLLC

  • Clinical Psychologist
  • Coon Rapids, MN
  • NPI 1770194417
  NPD

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1851963748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335869",
            "telephone_number": "651-728-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335869",
            "telephone_number": "651-240-2206",
            "fax_number": "612-466-5677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11417 Lily St NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554332704",
            "country_code": "US",
            "telephone_number": "612-423-0575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VESTAL",
        "first_name": "AMANDA",
        "credential": "LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305175",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC04032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Koenders Veldkamp, OD
• Arvind Vemula, MD
• James Conrad Verkuilen, OD
• Rajanshu Verma, MD
• Erin Ann Vesey, DPT
• Katherine Daniela Villa Ullaguari
• Alberto Villamiel, CRNA
• Vira Detox LLC
• Visionworks Inc.
• Vista Family Eye Care LLC

• Mental Health Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.