MEDICARE: BLUE CIRCLE ART THERAPY LLC

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1326728379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CIRCLE ART THERAPY LLC

Provider Business Mailing Address
First Line	:	1801 MORGAN AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 N 2ND ST # 302
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3407
Country	:	US
Telephone Number	:	612-470-5881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMZIE REEVES
Credential	:
Telephone Number	:	612-743-6959

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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