Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samara Fairwell, LADC, LPCC

Individual provider Professional Counselor · NPI 1770351918

Samara Fairwell, LADC, LPCC is a Mental Health Counselor in Coon Rapids, Minnesota. Qualified in 2023, 3 years ago. Practices with Nystrom and Associates Ltd, a 617-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2023
Specialties on file
2
What do these letters mean?
LADC — Licensed Alcohol and Drug Counselor
A licensed addiction counsellor.
LPCC — Licensed Professional Clinical Counselor
The title some states use for a licensed clinical counsellor.

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Practice location Address checks out

11660 Round Lake Blvd NW
Coon Rapids, MN 55433-2638
Phone: (844) 697-8766
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1900 Silver Lake Rd Nw, New Brighton, MN 55112-1786 — (866) 938-4159

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 5428 (MN)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 306766 (MN)

Record details

NPI number1770351918
Entity typeIndividual (Type 1)
GenderFemale
Credentials LADC , LPCC
Sole proprietorNo
NPI enumeratedDecember 18, 2023
Last updated in NPPESFebruary 23, 2026
Certification dateFebruary 23, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Nystrom And Associates Ltd — 617 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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