Nicole Marie-Ange Overby, LMFT, LADC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3404 Issued in MN

Practice address

14040 Northdale Blvd Ste 100
Rogers, MN 55374-9612

Phone

(763) 488-4100

Fax

(763) 488-4105

NPI assigned

Oct 11, 2017

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

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

Marriage and Family Therapist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment Care Compare group NPD
• Fairview Express Care

  • Pediatrics Physician
  • Chaska, MN
  • NPI 1043991904
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD

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

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1689184079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 LAKE ST N",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099499",
            "telephone_number": "320-282-3528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14040 NORTHDALE BLVD STE 100",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749612",
            "telephone_number": "763-488-4100",
            "fax_number": "763-488-4105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2807 Brookdale Dr",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Park",
            "state": "MN",
            "postal_code": "554441844",
            "country_code": "US",
            "telephone_number": "651-348-5652",
            "fax_number": "763-503-4820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OVERBY",
        "first_name": "NICOLE",
        "middle_name": "MARIE-ANGE",
        "credential": "LMFT, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-11",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304650",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brittany Pavlicek, PHARM D
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• Marriage & Family Therapist in Rogers, MN
• Providers in Rogers, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2019; 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.