=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417491689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUSSE & REID LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2016
-----------------------------------------------------
Last Update Date | 07/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6001 EGAN DR STE 170
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-4919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-219-8633
-----------------------------------------------------
Fax | 612-930-0111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 916 ARABIAN DR
-----------------------------------------------------
City | JORDAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55352-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-219-8633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KIMBERLY BUSSE
-----------------------------------------------------
Credential | M.ED., MA, LPCC
-----------------------------------------------------
Telephone | 612-219-8633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 01313
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 01314
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------