Mari Gwyn Anderson Fairchild, LADC
Individual provider Active NPI Mental Health Counselor · Minnetonka, MN
NPI 1487596409 · NPPES record last updated Aug 17, 2026
Key facts
- NPI
- 1487596409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 5770 (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
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 307588 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5770 | MN | Yes |
| 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
Other providers in Minnetonka, MN
- Karie Amstutz
- Abigail Amundson
- Sara Jane Amundson
- Anchored Orthodontics PLLC
- Ashley Carol Andersen
- Alex Kelly Anderson
- Brittany Marie Anderson
- Cynthia Lynne Anderson
- Derek Steven Anderson
- Erin Anderson
All providers in Minnetonka, MN · Mental Health Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.