Tia Dvorak, MS LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2822 Issued in MN

Practice address

18336 Joplin St NW
Elk River, MN 55330-1773

Phone

(763) 350-9687

Fax

(651) 447-5394

NPI assigned

Jul 31, 2015

Last updated

Apr 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Regroup Counseling and Consulting PSC

  • Marriage & Family Therapist
  • Elk River, MN
  • NPI 1194298026
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1912383969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18336 JOPLIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301773",
            "telephone_number": "763-350-9687",
            "fax_number": "651-447-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18336 JOPLIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301773",
            "telephone_number": "763-350-9687",
            "fax_number": "651-447-5394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 4th St S Ste 201",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "MN",
            "postal_code": "553714754",
            "country_code": "US",
            "telephone_number": "763-350-9687",
            "fax_number": "651-447-5394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DVORAK",
        "first_name": "TIA",
        "credential": "MS LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2822",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://regroupcounseling.org",
            "affiliation": "N",
            "endpointDescription": "Client portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "portal",
            "address_1": "18336 Joplin St NW",
            "city": "Elk River",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553301773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Marriage & Family Therapist in Elk River, MN
• Providers in Elk River, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.