MEDICARE: BURNSVILLE COUNSELING & HEALING CENTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518963750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNSVILLE COUNSELING & HEALING CENTER

Provider Business Mailing Address
First Line	:	17305 CEDAR AVE. S.
Second Line	:	SUITE 230
City	:	LAKEVILLE
State	:	MN
Zip	:	55044
Country	:	US
Telephone Number	:	952-435-4144
Fax Number	:	952-435-4149

Provider Business Practice Location Address
First Line	:	17305 CEDAR AVE. S.
Second Line	:	SUITE 230
City	:	LAKEVILLE
State	:	MN
Zip	:	55044
Country	:	US
Telephone Number	:	952-435-4144
Fax Number	:	952-435-4149

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAULA BECKER
Credential	:	MA,LP
Telephone Number	:	952-435-4144

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2020

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