Active NPI
Sada Kathryn Puckett, LPCC, LADC
- Mental Health Counselor
- Plymouth, MN
National Provider Identifier
1104497973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 02663
- Practice address
- 2415 Annapolis LN N Ste 130
Plymouth, MN 55441-3632 - Phone
- (763) 220-0218
- NPI assigned
- Jul 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 304393 | MN | |
| Mental Health Counselor | 101YM0800X | 02663 | MN | Primary |
Addresses
Primary practice location
2415 Annapolis LN N Ste 130
Plymouth, MN 55441-3632
Mailing address
2415 Annapolis LN N Ste 130
Plymouth, MN 55441-3632
Phone (763) 220-0218
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304393 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 02663 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649376000000",
"number": "1104497973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 ANNAPOLIS LN N STE 130",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413632",
"telephone_number": "763-220-0218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 ANNAPOLIS LN N STE 130",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554413632",
"telephone_number": "763-220-0218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "SADA",
"middle_name": "KATHRYN",
"credential": "LPCC, LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-02",
"last_updated": "2022-04-08",
"certification_date": "2022-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "304393",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "02663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.