MEDICARE: EDGES WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1306389861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGES WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	730 E 38TH ST STE 101
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-5218
Country	:	US
Telephone Number	:	612-217-0584
Fax Number	:	888-778-2961

Provider Business Practice Location Address
First Line	:	730 E 38TH ST
Second Line	:	SUITE 101
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2572
Country	:	US
Telephone Number	:	612-272-3016
Fax Number	:	888-778-2961

Authorized Official
Title or Position	:	PARTNER THERAPIST
Name	:	MR. MARK J REESE
Credential	:	LMFT
Telephone Number	:	612-272-3016

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	12/10/2025

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