KYLE JOHANNESSEN LPCC
NPI 1851923445
Counselor - Professional in Coon Rapids, MN

Active since February 11, 2020PECOS EnrolledAccepts Medicare Assignment
9120 SPRINGBROOK DR NW, COON RAPIDS, MN 55433(612) 767-7222 Get Directions Write a Review

NPPES record last updated: September 5, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 5, 2024, Feb 11, 2020 (2 updates tracked since 2020).

About Kyle Johannessen Lpcc NPPES

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

KYLE JOHANNESSEN LPCC (NPI 1851923445) is an individual professional provider in Coon Rapids, Minnesota, licensed in Minnesota (CC02342) and active in the NPI registry since February 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in Duluth, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1851923445
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameKYLE JOHANNESSENCredential: LPCC
Location Address9120 SPRINGBROOK DR NWCoon Rapids, MN 55433-5845
Mailing Address9120 Springbrook Dr NwCoon Rapids, MN 55433-5845 · (612) 767-7222
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateFebruary 11, 2020
Last NPPES UpdateSeptember 5, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 5, 2024
NPI 1851923445 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License Licensed in MN · CC02342
9120 SPRINGBROOK DR NW, Coon Rapids, MN 55433

Secondary Practice Location 1

Location 14849 Ivanhoe StDuluth, MN 55804-1131 · Phone (218) 728-7418 · Fax (218) 728-7467

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

Kyle Johannessen 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 ID3274074299
PECOS Enrollment IDI20240918001218
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 20

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

Marriage & Family Therapist
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Counselor (Mental Health)
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Counselor (Professional)
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Marriage & Family Therapist
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Marriage & Family Therapist
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Behavior Technician
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Marriage & Family Therapist
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433
Behavior Technician
9120 SPRINGBROOK DR NW
COON RAPIDS, MN 55433

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1851923445, enumerated as an "individual" on February 11, 2020.

The provider is located at 9120 SPRINGBROOK DR NW COON RAPIDS, MN 55433 and the phone number is (612) 767-7222.

Counselor with taxonomy code 101YP2500X and a focus in Professional.

The provider might be accepting Accepts: HealthPartners. Please consult your insurance carrier or call the provider to verify.