Trista M Gottwalt, MS, LADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4115 Issued in MN

Practice address

2104 Northdale Blvd NW Ste 220
Coon Rapids, MN 55433-3046

Phone

(763) 537-6000

NPI assigned

Jun 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nura PLLCGroup PAC ID 2769378942, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Nura PLLC

  • Pain Medicine Physician
  • Minneapolis, MN
  • NPI 1750316014
  Medicare reassignment Care Compare group NPD
• Nura PLLC

  • Prosthetic/Orthotic Supplier
  • Woodbury, MN
  • NPI 1932995040
  NPD

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1184291049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW STE 220",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333046",
            "telephone_number": "763-537-6000",
            "fax_number": "763-537-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW STE 220",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333046",
            "telephone_number": "763-537-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7400 France Ave S Ste 100",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554354738",
            "country_code": "US",
            "telephone_number": "763-537-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOTTWALT",
        "first_name": "TRISTA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "MS, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306045",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "trista.gottwalt.p21@direct.painphysicians.nextgenshare.com",
            "affiliation": "N",
            "address_1": "2140 Northdale Blvd NW # 220",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554333005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicholas M Gonzales
• Sara Jayne Goranowski, OTD
• Christopher JG Gordon, PA-C
• Dianne M Gordon, LICSW
• Gabriel Daniel Gornet, DPT
• Ronald P Gourneau, MD
• Richa Goyal, M.D.
• Kim Nicole Grabe, OT
• Grace Assisted Living LLC
• Joseph L Graif, M.D.

• Mental Health Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.