DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: SAMARA FAIRWELL LADC, LPCC

MEDICARE: SAMARA FAIRWELL LADC, LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor5428MN
2101YA0400XAddiction (Substance Use Disorder) Counselor306766MN

General Provider Information

NPI Number : 1770351918
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMARA FAIRWELL LADC, LPCC
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 866-938-4159
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 11660 ROUND LAKE BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-2638
Country : US
Telephone Number : 844-697-8766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2023
Last Update Date : 02/23/2026

Similar Medicare Providers

1114641537 — AUGUSTUS KJOLHAUG MA
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-767-3350
Practice Fax:
1336439306 — ELIZABETH A DOUGLAS MA, LADC, LPCC
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-439-4984
Practice Fax: 763-767-0912
1730562919 — JULIE IVERSON
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-767-3350
Practice Fax:
1245753540 — JOAN ALEXANDRA KANE-COLEMAN
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-767-3350
Practice Fax: 763-767-0912
1205346459 — LYNSEY BARGER PA-C
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-274-3120
Practice Fax: 763-274-3121
1457833204 — JACLYN RACHELLE RICE
Practice Location Address:
11660 ROUND LAKE BLVD NW
COON RAPIDS, MN
55433-2638
Practice Phone: 763-767-3350
Practice Fax: 763-767-0912

Directions to “ SAMARA FAIRWELL LADC, LPCC” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.