Individual provider Active NPI

Jennifer Marie Nelson, MA

  • Community/Behavioral Health Agency
  • Golden Valley, MN
National Provider Identifier
1912925017
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
02466 Issued in MN
Practice address
8085 Wayzata Blvd Suite 215
Golden Valley, MN 55426
Phone
(206) 947-2645
Fax
(651) 493-2798
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X LH00008407 WA
Addiction (Substance Use Disorder) Counselor 101YA0400X CP60181716 WA
Mental Health Counselor 101YM0800X LH00008407 WA
Professional Counselor 101YP2500X 00212 MN
Community/Behavioral Health Agency 251S00000X LH00008407 WA
Community/Behavioral Health Agency 251S00000X 02466 MN Primary

Addresses

Primary practice location

8085 Wayzata Blvd Suite 215
Golden Valley, MN 55426

Mailing address

8085 Wayzata Blvd Suite 215
Golden Valley, MN 55426
Phone (206) 947-2645

Other identifiers 1

IdentifierTypeStateIssuer
1912925017MedicaidWA

Other names 1

  • Ms. Jennifer Rivers Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20250306001226 WA Practitioner - Mental Health Counselor 3375805781 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Practice addresses (Care Compare)

Shelton, WA 98584
Phone (323) 205-7088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00212MNMDProfessional Counselor
02466MNMDCommunity/Behavioral Health Agency
LH00008407WAMDCommunity/Behavioral Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Sondermind, P.a. Mental Health CurrentSince Feb 26, 2025 Accepting new patients
Mental Health Specialty Group PA Mental Health CurrentSince Apr 18, 2025 Accepting new patients
Intuitive Therapy & Consulting, LLC PastSince Aug 29, 2021 Accepting new patients
Nystrom & Associates, LTD PastSince May 4, 2013 Accepting new patients

Locations

1400 112th Ave SE
Ste 100
Bellevue, WA 98004
Phone (425) 455-2526

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1912925017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8085 WAYZATA BLVD SUITE 215",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "206-947-2645",
            "fax_number": "651-493-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8085 WAYZATA BLVD SUITE 215",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "206-947-2645",
            "fax_number": "651-493-2798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "LH00008407",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60181716",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00008407",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "00212",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "LH00008407",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "02466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912925017",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "RIVERS",
            "prefix": "MS.",
            "credential": "MA, LMHC, CDP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Golden Valley, MN

Sources for this page

Verify at the official NPI Registry.