Madilyn Myers, LPCC, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

306162 Issued in MN

Practice address

10990 95TH St NE
Otsego, MN 55362-8149

Phone

(763) 329-7195

Fax

(952) 448-6047

NPI assigned

Jun 24, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1285366757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MARSCHALL RD STE 300",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792690",
            "telephone_number": "952-856-3932",
            "fax_number": "952-448-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10990 95TH ST NE",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553628149",
            "telephone_number": "763-329-7195",
            "fax_number": "952-448-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "MADILYN",
        "credential": "LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3262",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "madilyn.myers@northstarregional.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7384 Kirkwood Ct N Ste 200",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553695267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Otsego, MN
• Providers in Otsego, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.