Kimberly Stubblefield, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC04698 Issued in MN

Practice address

9298 Central Ave NE Ste 310
Blaine, MN 55434-4219

Phone

(651) 955-4633

Fax

(651) 440-9827

NPI assigned

Dec 10, 2024

Last updated

Aug 21, 2025By 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

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 Arts

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.

• Omni Mental Health Inc

  • Marriage & Family Therapist
  • Blaine, MN
  • NPI 1891110177

  Mental Health

  Medicare reassignment NPD

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1972319341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 RUTH ST N STE 101",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194409",
            "telephone_number": "651-955-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9298 CENTRAL AVE NE STE 310",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344219",
            "telephone_number": "651-955-4633",
            "fax_number": "651-440-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBBLEFIELD",
        "first_name": "KIMBERLY",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-10",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC04698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve's Transportation LLC
• Rebecca Ann Stewart, PHARMD
• Devlin Stitt, LPN
• Patricia Lynn Stock, NP-C
• John W Stoulil, PAC
• Ann Studniski
• Jeffrey Michael Styba, D.C.
• Success Arena Home Health and Social Services (Success Arena Home Health)
• Success Arena Home Health and Social Services
• Samira Sugule, MD

• Mental Health Counselor in Blaine, MN
• Providers in Blaine, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.