Individual provider Active NPI

Kristy Costello

  • Mental Health Counselor
  • Saint Paul, MN
National Provider Identifier
1871989897
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CC00964 Issued in MN
Practice address
2550 University Ave W
Saint Paul, MN 55114-1052
Phone
(651) 647-1900
NPI assigned
Apr 7, 2015
Last updated
Apr 7, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X CC00964 MN Primary

Addresses

Primary practice location

2550 University Ave W
Saint Paul, MN 55114-1052

Mailing address

2550 University Ave W
Saint Paul, MN 55114-1052
Phone (651) 647-1900

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
I20240216004430 MN Practitioner - Mental Health Counselor 1759733595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Center for Personal and Family Development, P.a.Group PAC ID 3173436185, 17 clinicians

Practice addresses (Care Compare)

2550 University Ave W
Saint Paul, MN 55114-1052
Phone (651) 647-1900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Law

State licenses

LicenseStateTypeSpecialty
CC00964MNMDMental Health Counselor
964MNMDOrthotic Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Center for Personal & Family Development PA CurrentSince Jan 1, 2024 Accepting new patients
Pathway Virtu-Health Past Accepting new patients

Locations

2550 University Ave W
Saint Paul, MN 55114
Phone (651) 645-3115

2550 University Ave W
Ste 435S
Saint Paul, MN 55114
Phone (651) 286-8527

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, 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": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428364800000",
    "number": "1871989897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-647-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-647-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "KRISTY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC00964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.