Active NPI
Melissa Ann Poehler, LADC
- Addiction (Substance Use Disorder) Counselor
- Big Lake, MN
National Provider Identifier
1932614518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 302424
- Practice address
- 410 Martin Ave
Big Lake, MN 55309-8004 - Phone
- (763) 607-6344
- NPI assigned
- Dec 5, 2017
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302424 | MN | Primary |
Addresses
Primary practice location
410 Martin Ave
Big Lake, MN 55309-8004
Mailing address
410 Martin Ave
Big Lake, MN 55309-8004
Phone (763) 607-6344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302424 | Other | MN | MN BOARD OF BEHAVIORAL HEALTH LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302424 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1932614518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 MARTIN AVE",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553098004",
"telephone_number": "763-607-6344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 MARTIN AVE",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553098004",
"telephone_number": "763-607-6344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POEHLER",
"first_name": "MELISSA",
"middle_name": "ANN",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "302424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BOARD OF BEHAVIORAL HEALTH LICENSE",
"identifier": "302424",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.