Mark Molyneaux, M.A., L.P.C.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01214 Issued in MN

Practice address

1875 Station Pkwy NW
Andover, MN 55304-3319

Phone

(763) 482-9598

Fax

(612) 235-6447

NPI assigned

Jun 7, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Rum River Counseling, Inc.

  • Marriage & Family Therapist
  • Andover, MN
  • NPI 1073578472

  Professional

  Medicare reassignment NPD
• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1962851303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598",
            "fax_number": "612-235-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598",
            "fax_number": "612-235-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLYNEAUX",
        "first_name": "MARK",
        "credential": "M.A., L.P.C.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milk Moms, Inc
• Milk Moms, Inc (Heather's Mastectomy Boutique)
• Samantha Nichole Mogen, LICSW
• Nicole Elaine Mold, OTR/L
• Brooke Marie Mollan, LMFT
• Mikayla Money
• Moore Therapies, PLLC
• Brian Moore, LPCC
• Kathleen D Moore, MA, CCC-SLP
• Nicole Morrissey

• Professional Counselor in Andover, MN
• Providers in Andover, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.