Active NPI
Autumn E. S. R. Fancher, LPCC
- Professional Counselor
- Coon Rapids, MN
National Provider Identifier
1508456591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4936
- Practice address
- 11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638 - Phone
- (763) 767-3350
- Fax
- (763) 767-0912
- NPI assigned
- Jan 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4936 | MN | Primary |
Addresses
Primary practice location
11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Mailing address
1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566
Other names 1
- Joshua Lee Fancher
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260323000348 | MN | Practitioner - Mental Health Counselor | 0244714863 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Phone (763) 767-3350
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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": "1611273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788480000000",
"number": "1508456591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW STE 110",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121789",
"telephone_number": "651-628-9566",
"fax_number": "651-628-0411"
},
{
"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": "763-767-3350",
"fax_number": "763-767-0912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANCHER",
"first_name": "AUTUMN",
"middle_name": "E. S. R.",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-22",
"last_updated": "2026-09-04",
"certification_date": "2026-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "4936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOSHUA",
"last_name": "FANCHER",
"middle_name": "LEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; 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.