Individual provider Active NPI

Kyle Erich Dufek

  • Mental Health Counselor
  • Coon Rapids, MN
National Provider Identifier
1932717022
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Phone
(763) 767-3350
NPI assigned
Jul 15, 2020
Last updated
Jul 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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 NU Primary

Addresses

Primary practice location

11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789

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
I20231229001308 MN Practitioner - Mental Health Counselor 9032569272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Phone (763) 767-3350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3406MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Jan 1, 2024 Accepting new patients
Family Support Services Inc. Mental Health PastSince May 30, 2023 Accepting new patients

Locations

11660 Round Lake Blvd NW
Coon Rapids, MN 55433
Phone (763) 317-0718

1702 Miller Trunk Hwy
Ste 209
Duluth, MN 55811
Phone (218) 318-1348

114 Main St N
Ste 201B
Hutchinson, MN 55350
Phone (320) 753-0778

17685 Juniper Path
Ste 303
Lakeville, MN 55044
Phone (952) 214-8959

201 N Broad St
Ste 200
Mankato, MN 56001
Phone (507) 200-2624

1856 Beam Ave
#200
Maplewood, MN 55109
Phone (651) 661-6550

1101 E 78th St
Ste 100
Minneapolis, MN 55420
Phone (952) 234-8604

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

101 Dehler Dr
Sartell, MN 56377
Phone (320) 253-3512

1811 Weir Dr
Ste 270
Woodbury, MN 55125
Phone (651) 243-6087

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": "1594771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1932717022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11660 ROUND LAKE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332638",
            "telephone_number": "763-767-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFEK",
        "first_name": "KYLE",
        "middle_name": "ERICH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-15",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.