Individual provider Active NPI

Brett Sharockman

  • Professional Counselor
  • Eden Prairie, MN
National Provider Identifier
1104414515
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4208 Issued in MN
Practice address
11010 Prairie Lakes Dr Ste 350
Eden Prairie, MN 55344-3801
Phone
(952) 746-2522
NPI assigned
Jan 3, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 305850 MN
Professional Counselor 101YP2500X 4208 MN Primary
Mental Health Counselor 101YM0800X 11496-125 WI

Addresses

Primary practice location

11010 Prairie Lakes Dr Ste 350
Eden Prairie, MN 55344-3801

Mailing address

8044 Belair LN
Eden Prairie, MN 55347-1103
Phone (507) 400-8635

Other practice location 1

5275 Edina Industrial Blvd Ste 124
Edina, MN 55439-2903
Phone (507) 400-8635

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
I20240304000482 MN Practitioner - Mental Health Counselor 7315382116 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

11010 Prairie Lakes Dr
Suite 350
Eden Prairie, MN 55344-3801
Phone (952) 746-2522

5275 Edina Industrial Blvd
Suite 124
Edina, MN 55439-2903
Phone (507) 400-8635

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
305850MNMDAddiction (Substance Use Disorder) Counselor
11496-125WIMDMental Health Counselor
4208MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Sharockman Counseling Mental Health CurrentSince Dec 22, 2025 Accepting new patients
Nystrom & Associates, LTD CurrentSince Jan 20, 2024 Accepting new patients
Family Support Services Inc. Mental Health Past Accepting new patients

Locations

5275 Edina Industrial Blvd
Ste 124
Edina, MN 55439
Phone (952) 835-7130

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

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

Organizations & group practices 3

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": "1609632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1104414515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8044 BELAIR LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553471103",
            "telephone_number": "507-400-8635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 PRAIRIE LAKES DR STE 350",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443801",
            "telephone_number": "952-746-2522"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5275 Edina Industrial Blvd Ste 124",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554392903",
            "country_code": "US",
            "telephone_number": "507-400-8635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAROCKMAN",
        "first_name": "BRETT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-03",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305850",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4208",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "11496-125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.