Carly Cristine McCormack, LADC, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3936 Issued in MN

Practice address

12775 Swallow St NW
Coon Rapids, MN 55448-2587

Phone

(701) 850-7438

NPI assigned

Feb 11, 2021

Last updated

Sep 2, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Carly Cristine Rutter Former name

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affinity Psychological Services, P.C.

  • Mental Health Counselor
  • Edina, MN
  • NPI 1245610856
  Medicare reassignment NPD
• McCormack Behavioral Health

  • Mental Health Counselor
  • Coon Rapids, MN
  • NPI 1255136255
  NPD Authorized official
• Mindful Way Counseling, LLC

  • Clinical Social Worker
  • Fridley, MN
  • NPI 1336615202

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1700478625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553030019",
            "telephone_number": "612-208-9541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12775 SWALLOW ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482587",
            "telephone_number": "701-850-7438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "CARLY",
        "middle_name": "CRISTINE",
        "credential": "LADC, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-11",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305956",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3936",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "3936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "RUTTER",
            "middle_name": "CRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• MC Transportation Services LLC
• Jennifer McCarty
• Jessica McClure, PA-C
• Paul Charles McCollum, LADC
• McCormack Behavioral Health
• James Andrew McCoy, MD
• Jane McCrossen, RN CNP
• Elizabeth Anastasia McDevitt, PMNHP
• Jennifer McDonnell, PHARMD
• Alexandra Jo McDonough

• 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 Sep 2, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.