Individual provider Active NPI

Andrew Carson, MA

  • Mental Health Counselor
  • Plymouth, MN
National Provider Identifier
1124624614
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4100 Berkshire LN N Ste 250
Plymouth, MN 55446-3813
Phone
(612) 223-8898
Fax
(833) 972-0904
NPI assigned
Dec 9, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 4464 MN
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

4100 Berkshire LN N Ste 250
Plymouth, MN 55446-3813

Mailing address

1601 4TH Ave S
Buffalo, MN 55313-1283
Phone (763) 245-2576

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
I20240819002581 MN Practitioner - Marriage and Family Therapist 7214475458 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Behavioral Care of Colorado PCGroup PAC ID 0941648463, 196 clinicians

Practice addresses (Care Compare)

4100 Berkshire LN N
Suite 250
Plymouth, MN 55446-3813
Phone (612) 223-8898

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4464MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Colorado, P.C. Current Accepting new patients
Plymouth Psych Group, LLC Mental Health CurrentSince Jun 6, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Apr 15, 2025 Accepting new patients
Care Clinics, LLC CurrentSince Dec 23, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Apr 15, 2025 Accepting new patients
Optum Behavioral Care of Colorado PC PastSince Nov 17, 2024 Accepting new patients

Locations

7400 W 109th St
Bloomington, MN 55438
Phone (952) 886-3268

4100 Berkshire Ln N
#250
Plymouth, MN 55446

3021 Harbor Ln N
Ste 206
Plymouth, MN 55447
Phone (763) 559-1640

4100 Berkshire Ln N
Ste 250
Plymouth, MN 55446

9655 Schmidt Lake Rd
Ste 150
Plymouth, MN 55442
Phone (763) 559-1640

7601 Wayzata Blvd
St Louis Park, MN 55426
Phone (612) 223-8899

Organizations & group practices 6

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": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1124624614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 4TH AVE S",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131283",
            "telephone_number": "763-245-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 BERKSHIRE LN N STE 250",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463813",
            "telephone_number": "612-223-8898",
            "fax_number": "833-972-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSON",
        "first_name": "ANDREW",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-09",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4464",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.