Individual provider Active NPI

John Merrick, MA, LPC

  • Mental Health Counselor
  • Richfield, MN
National Provider Identifier
1871954396
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
6636 Cedar Ave S Ste 360
Richfield, MN 55423-2712
Phone
(612) 268-5858
NPI assigned
Mar 10, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 180.011069 IL
Mental Health Counselor 101YM0800X Primary
Counselor 101Y00000X 178.009374 IL

Addresses

Primary practice location

6636 Cedar Ave S Ste 360
Richfield, MN 55423-2712

Mailing address

466 Buchanan CT
Vernon Hills, IL 60061-1346
Phone (309) 530-7410

Other practice location 1

7401 Metro Blvd Ste 250
Edina, MN 55439-3062
Phone (612) 268-5858

Other practice location 2

1111 W Lake Cook Rd
Buffalo Grove, IL 60089-1926
Phone (309) 557-1442

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240607001750 MN Practitioner - Mental Health Counselor 4789126558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Affinity Psychological Services PCGroup PAC ID 0749528552, 66 clinicians

Practice addresses (Care Compare)

3251 Fernbrook LN N
Plymouth, MN 55447-5352
Phone (612) 268-5858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
178.009374ILMDCounselor
180.011069ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Psychological Services, P.C. Mental Health CurrentSince Mar 26, 2024 Accepting new patients

Locations

7401 Metro Blvd
Ste 250
Minneapolis, MN 55439
Phone (612) 778-8393

7401 Metro Blvd
Ste 525
Minneapolis, MN 55439

3251 Fernbrook Ln N
Plymouth, MN 55447

6636 Cedar Ave S
Ste 360
Richfield, MN 55423
Phone (612) 998-8934

3400 1st St N
Ste 101
Saint Cloud, MN 56303
Phone (320) 202-2000

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": "1457568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1871954396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 BUCHANAN CT",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611346",
            "telephone_number": "309-530-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6636 CEDAR AVE S STE 360",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232712",
            "telephone_number": "612-268-5858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7401 Metro Blvd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554393062",
            "country_code": "US",
            "telephone_number": "612-268-5858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 W Lake Cook Rd",
            "address_purpose": "LOCATION",
            "city": "Buffalo Grove",
            "state": "IL",
            "postal_code": "600891926",
            "country_code": "US",
            "telephone_number": "309-557-1442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRICK",
        "first_name": "JOHN",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-10",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.011069",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.009374",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richfield, MN

Sources for this page

Verify at the official NPI Registry.