Elizabeth A Douglas, MA, LADC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2409 Issued in MN

Practice address

11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638

Phone

(763) 439-4984

Fax

(763) 767-0912

NPI assigned

Apr 12, 2011

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

Other names 1

• Elizabeth A Myhre Former name

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, 2016

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Yellow Wallpaper Therapy LLC

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1376315549

  Addiction (Substance Use Disorder)

  Medicare reassignment NPD Authorized official
• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment NPD

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1336439306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11660 ROUND LAKE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332638",
            "telephone_number": "763-439-4984",
            "fax_number": "763-767-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11660 ROUND LAKE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332638",
            "telephone_number": "763-439-4984",
            "fax_number": "763-767-0912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2807 Brookdale Dr",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Park",
            "state": "MN",
            "postal_code": "554441844",
            "country_code": "US",
            "telephone_number": "651-200-6088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3329 University Ave SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554143325",
            "country_code": "US",
            "telephone_number": "612-454-2281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "ELIZABETH",
        "middle_name": "A",
        "credential": "MA, LADC, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-12",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302188",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elizabethd@valhallaplace.com",
            "affiliation": "N",
            "endpointDescription": "provider contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2807 Brookdale Dr",
            "city": "Brooklyn Park",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554441844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "MYHRE",
            "middle_name": "A",
            "credential": "BA, LADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa Domeyer, DDS
• Brittney Anne Donley
• Kalil Donzo
• Tristin Dooley
• Maria Angela Doran-Threat, NP-C
• Michelle Marie Douvier, PA-C
• Anne Elizabeth Drabot, PA-C
• Anna M Drewry, M.D.
• R Todd Drexel, MD
• Judith Ann Driscoll, L.M.F.T.

• 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 Oct 23, 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.