Carlyn Becker

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01826 Issued in MN

Practice address

25210 Hazelwood Dr
Nisswa, MN 56468-2797

Phone

(763) 438-4619

NPI assigned

Feb 24, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Carlyn Becker Therapy Services

  • Community/Behavioral Health Agency
  • Nisswa, MN
  • NPI 1922584879
  NPD Authorized official

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1194185728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25210 HAZELWOOD DR",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564682797",
            "telephone_number": "763-438-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25210 HAZELWOOD DR",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564682797",
            "telephone_number": "763-438-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "CARLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-24",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303742",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Acquire Mental Health Clinic
• Angie Monson Therapy Services, LLC
• Gary Bridgwater, M.D.
• Carlyn Becker Therapy Services
• Beatrice Marie-Rachelle Comty-Charnock, LMFT, LADC
• Shana Crouse
• Cuyuna Regional Medical Center

• Professional Counselor in Nisswa, MN
• Providers in Nisswa, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.