KIRBY KACZOR LPCC
NPI 1003679234
Counselor in White Bear Lake, MN

Active since January 31, 2024PECOS EnrolledAccepts Medicare Assignment
2025 4TH ST STE 100, WHITE BEAR LAKE, MN 55110(651) 212-4920 Get Directions Write a Review

NPPES record last updated: January 31, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kirby Kaczor Lpcc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIRBY KACZOR LPCC (NPI 1003679234) is an individual counselor in White Bear Lake, Minnesota, licensed in Minnesota (4263) and active in the NPI registry since January 2024. He is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1003679234
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameKIRBY KACZORCredential: LPCC
Location Address2025 4TH ST STE 100White Bear Lake, MN 55110-2875
Mailing Address2025 4th St Ste 100White Bear Lake, MN 55110-2875 · (651) 212-4920
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateJanuary 31, 2024
NPPES CertifiedJanuary 31, 2024
NPI 1003679234 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
License Licensed in MN · 4263
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
2025 4TH ST STE 100, White Bear Lake, MN 55110

Secondary Practice Location 1

Location 14432 Chicago Ave Ste 1Minneapolis, MN 55407-3521 · Phone (612) 870-2454

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kirby Kaczor Lpcc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7911341102
PECOS Enrollment IDI20240215001691
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Professional)
2025 4TH ST STE 100
WHITE BEAR LAKE, MN 55110
Counselor (Mental Health)
2025 4TH ST STE 100
WHITE BEAR LAKE, MN 55110
Counselor (Professional)
2025 4TH ST STE 100
WHITE BEAR LAKE, MN 55110
Counselor (Mental Health)
2025 4TH ST STE 100
WHITE BEAR LAKE, MN 55110

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kirby Kaczor's NPI number?

The NPI number for Kirby Kaczor is 1003679234. It was assigned to this individual provider in the NPPES registry on January 31, 2024.

Where is Kirby Kaczor located?

Kirby Kaczor practices at 2025 4th St Ste 100, White Bear Lake, MN 55110. The listed phone number is (651) 212-4920.

What is Kirby Kaczor's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Kirby Kaczor enrolled in Medicare?

Yes. Kirby Kaczor is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kirby Kaczor accept?

Health plans from HealthPartners list Kirby Kaczor as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kirby Kaczor was last updated on January 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.