Samara Fairwell, LADC, LPCC
NPI 1770351918ActiveIndividual· Counselor, Professional· Coon Rapids, MN
Counselor, Professional (LADC, LPCC) with Nystrom and Associates Ltd, practicing in Coon Rapids, Minnesota. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1770351918 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LADC, LPCC |
| Sole proprietor | No |
| NPI issued | Dec 18, 2023 |
| Last updated in NPPES | Feb 23, 2026 |
| Certified by provider | Feb 23, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 5428 | MN |
| Counselor, Addiction (Substance Use Disorder) | 101YA0400X | 306766 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (MN) |
|---|
Education and affiliations
| Graduation year | 2023 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Nystrom and Associates LtdBaxter, MN · 590 clinicians
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