MEDICARE: AMZIE ELIZABETH REEVES MA

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	3977	MN
2	101YM0800X	Mental Health Counselor
3	221700000X	Art Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326728379	OTHER	MN	BLUE CIRCLE ART THERAPY LLC

General Provider Information

NPI Number	:	1740893957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMZIE ELIZABETH REEVES MA

Provider Business Mailing Address
First Line	:	3534 BRYANT AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-2542
Country	:	US
Telephone Number	:	612-743-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 N 2ND ST STE 302
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3448
Country	:	US
Telephone Number	:	612-470-5881
Fax Number	:	612-389-9637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	12/15/2023

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