Mystal Rae Axtman, M.S., LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

472-3-1-02-164 Issued in ND

Practice address

4675 40TH Ave S Ste 115
Fargo, ND 58104-4592

Phone

(701) 478-0906

NPI assigned

Feb 9, 2007

Last updated

Feb 15, 2023By the provider in NPPES

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

Enrolled in ND

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Inner Light Counseling Services LTDGroup PAC ID 4082057500, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Inner Light Counseling Services, LTD

  dba Inner Light Counseling Services

  • Professional Counselor
  • Fargo, ND
  • NPI 1740861954

  Mental Health

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1285775569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4675 40TH AVE S STE 115",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044592",
            "telephone_number": "701-541-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4675 40TH AVE S STE 115",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044592",
            "telephone_number": "701-478-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXTMAN",
        "first_name": "MYSTAL",
        "middle_name": "RAE",
        "credential": "M.S., LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ND",
            "license": "472-3-1-02-164",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ND",
            "license": "472-3-1-02-164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Komivi T Avegnon
• Avera St. Luke's (Cosmetics and Plastic Surgery)
• Aw Transport LLC
• Khadija A Awes
• Awesome Incorporated
• Gemechu Shiferaw Ayana, MD
• Michael Ayi, CNA
• Matthew James Aymond, DPT
• Ghufran Azam I, MD
• Azizas Residential Care LLC

• Professional Counselor in Fargo, ND
• Providers in Fargo, ND by specialty
• Professional Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.