Individual provider Active NPI

Charme S. Davidson, PH.D., ABPP

  • Marriage & Family Therapist
  • Minneapolis, MN
National Provider Identifier
1285687889
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT0245 Issued in MN
Practice address
1409 Willow St
Suite 220
Minneapolis, MN 55403-2269
Phone
(612) 870-0510
Fax
(612) 870-4542
NPI assigned
May 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP2642 MN
Marriage & Family Therapist 106H00000X MFT0245 MN Primary

Addresses

Primary practice location

1409 Willow St
Suite 220
Minneapolis, MN 55403-2269

Mailing address

5401 Pleasant Ave
Minneapolis, MN 55419-1846
Phone (612) 825-2868

Other identifiers 4

IdentifierTypeStateIssuer
6275478000MedicaidMN
LP2642OtherMNMN PSYCHOLOGY LICENSE #
0245OtherMNMN MARRIAGE & FAM LIC #
3962OtherMNABPP #

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
I20061023000028 MN Practitioner - Clinical Psychologist 9931106648 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1978
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

475 Cleveland Ave N
Suite 200
Saint Paul, MN 55104-5053
Phone (612) 870-0510

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
LP2642MNMDPsychologist
MFT0245MNMDMarriage & Family Therapist
2642MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Charme S. Davidson, LLC Psychologist CurrentSince Nov 1, 2006 Accepting new patients

Locations

1409 Willow St
Ste 220
Minneapolis, MN 55403
Phone (612) 870-0216

475 Cleveland Ave N
Ste 200
Saint Paul, MN 55104
Phone (612) 802-9164

Organizations & group practices 1

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1285687889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 PLEASANT AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191846",
            "telephone_number": "612-825-2868",
            "fax_number": "612-870-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 WILLOW ST",
            "address_2": "SUITE 220",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554032269",
            "telephone_number": "612-870-0510",
            "fax_number": "612-870-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "CHARME",
        "middle_name": "S.",
        "credential": "PH.D., ABPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2642",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "MFT0245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6275478000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN PSYCHOLOGY LICENSE #",
            "identifier": "LP2642",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN MARRIAGE & FAM LIC #",
            "identifier": "0245",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ABPP #",
            "identifier": "3962",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.