Individual provider Active NPI

Abigail Fletcher

  • Professional Counselor
  • Coon Rapids, MN
National Provider Identifier
1043670581
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
CC01153 Issued in MN
Practice address
3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599
Phone
(763) 767-3350
NPI assigned
Feb 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X CC01153 MN Primary

Addresses

Primary practice location

3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599

Mailing address

3833 Coon Rapids Blvd NW Ste 120
Coon Rapids, MN 55433-2599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240122003548 MN Practitioner - Mental Health Counselor 9032561444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

9245 Quantrelle Ave NE
Otsego, MN 55330-0168
Phone (763) 746-9492

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CC01153MNMDProfessional Counselor
1153MNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Jan 1, 2024 Accepting new patients
Family Support Services Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

11660 Round Lake Blvd NW
Coon Rapids, MN 55433
Phone (763) 317-0718

3833 Coon Rapids Blvd NW
Ste 120
Minneapolis, MN 55433
Phone (763) 433-2000

9245 Quantrelle Ave NE
Otsego, MN 55330
Phone (763) 308-8619

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1043670581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 COON RAPIDS BLVD NW STE 120",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332599",
            "telephone_number": "763-767-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "ABIGAIL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-25",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.