BETHANY R DILLON (MA, LPCC, CCTP) – Mental Health Counselor, NPI 1164039905

BETHANY R DILLON (MA, LPCC, CCTP) is a healthcare provider. based in Maple grove, Minnesota. specializing in MENTAL HEALTH COUNSELOR. They hold the professional credentials MA, LPCC, CCTP. They hold a License No. CC01872 (MN). The NPI Number for BETHANY R DILLON (MA, LPCC, CCTP) is 1164039905

Main info

Female
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
BETHANY R DILLON (MA, LPCC, CCTP)
NPI
1164039905
Phone
Not provided
Address
12918 63RD AVE N
Enumeration Date
25 September 2020
Last Update Date
25 September 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7632109966
Graduation Year
2015 (11 years ago)
PAC ID
0345691481
Group Practice PAC ID
3678711900
Professional Enrollment ID
I20240112002153
Address ID
MN553696001MA12918NXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

1,813 MENTAL HEALTH COUNSELOR in MN

Provider Addresses for BETHANY R DILLON (MA, LPCC, CCTP)

  • 12918 63RD AVE N

    MAPLE GROVE, MN 553696001

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-12

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240112002153IMental Health CounselorMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55369)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3678711900View full group profile
NameSpecialtyState
-KS
Marriage And Family TherapistNH
Clinical Social WorkerMN
Mental Health CounselorWI
Clinical PsychologistWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Clinical Social WorkerMN
Mental Health CounselorMN
Mental Health CounselorMN

Reviews

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Frequently asked questions

What is the 10-digit NPI for BETHANY R DILLON (MA, LPCC, CCTP)?
BETHANY R DILLON (MA, LPCC, CCTP) — NPI 1164039905 — is the standard way to identify this listing.
Does CMS list BETHANY R DILLON (MA, LPCC, CCTP) as active?
Yes — BETHANY R DILLON (MA, LPCC, CCTP) is active in the NPI listing used on this page.
What healthcare role does BETHANY R DILLON (MA, LPCC, CCTP) hold?
Scheduling teams often label BETHANY R DILLON (MA, LPCC, CCTP) under Mental Health Counselor. Clinical services aligned with this taxonomy classification.
What area does BETHANY R DILLON (MA, LPCC, CCTP) serve?
BETHANY R DILLON (MA, LPCC, CCTP)'s listing highlights Maple Grove, Minnesota; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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