Individual provider Active NPI

Mari Gwyn Anderson Fairchild, LADC

  • Mental Health Counselor
  • Minnetonka, MN
National Provider Identifier
1487596409
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
5770 Issued in MN
Practice address
5900 Green Oak Dr # 306
Minnetonka, MN 55343-4708
Phone
(952) 243-8707
Fax
(612) 484-3752
NPI assigned
Apr 8, 2026
Last updated
Aug 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 5770 MN Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 307588 MN

Addresses

Primary practice location

5900 Green Oak Dr # 306
Minnetonka, MN 55343-4708

Mailing address

5900 Green Oak Dr # 306
Minnetonka, MN 55343-4708
Phone (952) 243-8707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
307588MNMDAddiction (Substance Use Disorder) Counselor
5770MNMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1775606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1487596409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 GREEN OAK DR # 306",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434708",
            "telephone_number": "952-243-8707",
            "fax_number": "612-484-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 GREEN OAK DR # 306",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434708",
            "telephone_number": "952-243-8707",
            "fax_number": "612-484-3752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON FAIRCHILD",
        "first_name": "MARI",
        "middle_name": "GWYN",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-08",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "5770",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "307588",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.