Mary Anderson
Individual provider Active NPI Marriage & Family Therapist · Maplewood, MN
NPI 1124405667 · NPPES record last updated Jul 7, 2021
Key facts
- NPI
- 1124405667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 3779 (MN)
- Practice address
- 2103 B County Road D
Maplewood, MN 55109 - Phone
- (651) 748-5019
- Fax
- (651) 773-7591
- NPI assigned
- May 5, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250528001091 | MN | Practitioner - Marriage and Family Therapist | 1557880085 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3779 | MN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Innovations, Inc. | Marriage & Family Therapist | Current |
Accepting new patients |
| Pure Potential Counseling | Current |
Accepting new patients |
Locations
2103 County Road D E
Ste B
Saint Paul, MN 55109
Phone (651) 383-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | 3779 | MN | Yes |
Addresses
Primary practice location
2103 B County Road D
Maplewood, MN 55109
Mailing address
5800 Upper 183Rd St W
Farmington, MN 55024-8102
Phone (612) 743-0715
Other providers in Maplewood, MN
- Anchor and Bloom Counseling LLC
- Anchored Arms Healthcare Services LLC
- Dacotah Stephen Anderson
- Donald S Anderson
- Kari Malia Anderson
- Mary L Anderson
- Mary Sullivan Anderson
- Nancy R Anderson
- Andrew J Will MD PA
- Zehra Ansari
All providers in Maplewood, MN · Marriage & Family Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.