NPIMap

Individual provider Active NPI

Emily Pavlik, LADC, LMFT

  • Community/Behavioral Health Agency
  • Eagan, MN
National Provider Identifier
1962689554
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Practice address
4660 Slater Rd
Suite 225
Eagan, MN 55122
Phone
(651) 246-8895
Fax
(651) 344-7655
NPI assigned
Jan 25, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 301842 MN
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4660 Slater Rd
Suite 225
Eagan, MN 55122

Mailing address

4660 Slater Rd
Suite 225
Eagan, MN 55122
Phone (651) 246-8895

Other practice location 1

1911 Pleasant Ave. S.
CREATE Inc.
Minneapolis, MN 55403
Phone (612) 874-9811

Other identifiers 2

IdentifierTypeStateIssuer
2221OtherMNLMFT
301842OtherMNLADC

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

LicenseStateTypeSpecialty
301842MNMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Community Resources for Education Alternative Treatments & Evaluation Addiction (Substance Use Disorder) Past Accepting new patients
Create Inc Addiction (Substance Use Disorder) Past Accepting new patients
Pavlik Mental Health Community/Behavioral Health Past Accepting new patients

Organizations & group practices 3

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": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1962689554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 225",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "651-246-8895",
            "fax_number": "651-344-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 225",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "651-246-8895",
            "fax_number": "651-344-7655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1911 Pleasant Ave. S.",
            "address_2": "CREATE Inc.",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55403",
            "country_code": "US",
            "telephone_number": "612-874-9811",
            "fax_number": "612-874-9820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAVLIK",
        "first_name": "EMILY",
        "credential": "LADC, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-25",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301842",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMFT",
            "identifier": "2221",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC",
            "identifier": "301842",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.