Kirby Kaczor, LPCC
NPI 1003679234ActiveIndividual· Counselor· White Bear Lake, MN
Counselor (LPCC) with Vantage Mental Health, practicing in White Bear Lake, Minnesota. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1003679234 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LPCC |
| Sole proprietor | No |
| NPI issued | Jan 31, 2024 |
| Last updated in NPPES | Jan 31, 2024 |
| Certified by provider | Jan 31, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor Primary | 101Y00000X | 4263 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (MN) |
|---|
Education and affiliations
| Graduation year | 2021 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Vantage Mental HealthOak Park Heights, MN · 33 clinicians
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