Individual provider Active NPI

Chanel Shanni Lopez, MA, LPCC

  • Professional Counselor
  • Victoria, MN
National Provider Identifier
1861067233
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4430 Issued in MN
Practice address
1772 Stieger Lake LN
Victoria, MN 55386-7723
Phone
(952) 443-4600
NPI assigned
May 26, 2021
Last updated
Jun 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 4430 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1772 Stieger Lake LN
Victoria, MN 55386-7723

Mailing address

1772 Stieger Lake LN
Victoria, MN 55386-7723

Other names 1

  • Chanel Shanni Purcell Former name

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
I20240621001489 MN Practitioner - Mental Health Counselor 2769925585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parker Collins Family Mental Health PLLCGroup PAC ID 8325338031, 9 clinicians

Practice addresses (Care Compare)

11316 86TH Ave N
Maple Grove, MN 55369-4528
Phone (763) 400-8000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4430MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Parker Collins Family Mental Health, PLLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

11316 86th Ave N
Maple Grove, MN 55369
Phone (651) 300-0060

1056 Centerville Cir
Vadnais Heights, MN 55127
Phone (651) 493-2216

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, 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": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1861067233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 STIEGER LAKE LN",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553867723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 STIEGER LAKE LN",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553867723",
            "telephone_number": "952-443-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "CHANEL",
        "middle_name": "SHANNI",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4430",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANEL",
            "last_name": "PURCELL",
            "middle_name": "SHANNI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Victoria, MN

Sources for this page

Verify at the official NPI Registry.