Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kirby Kaczor, LPCC

Individual provider Counselor · NPI 1003679234

Kirby Kaczor, LPCC is a Mental Health Counselor in White Bear Lake, Minnesota. Qualified in 2021, 5 years ago. Practices with Vantage Mental Health, a 26-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
5
Licensed in
MN
In the registry since
2024
What do these letters mean?
LPCC — Licensed Professional Clinical Counselor
The title some states use for a licensed clinical counsellor.

See every abbreviation used in this directory →

Practice location Address checks out

2025 4th St Ste 100
White Bear Lake, MN 55110-2875
Phone: (651) 212-4920
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4432 Chicago Ave Ste 1, Minneapolis, MN 55407-3521 — (612) 870-2454

Specialties & licences

Counselor (primary) Taxonomy 101Y00000X · Licence 4263 (MN)

Record details

NPI number1003679234
Entity typeIndividual (Type 1)
GenderMale
Credentials LPCC
Sole proprietorNo
NPI enumeratedJanuary 31, 2024
Last updated in NPPESJanuary 31, 2024
Certification dateJanuary 31, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Vantage Mental Health — 26 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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