Provider Demographics
NPI:1740893957
Name:REEVES, AMZIE ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:AMZIE
Middle Name:ELIZABETH
Last Name:REEVES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 BRYANT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2542
Mailing Address - Country:US
Mailing Address - Phone:612-743-6959
Mailing Address - Fax:
Practice Address - Street 1:1729 N 2ND ST STE 302
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3448
Practice Address - Country:US
Practice Address - Phone:612-470-5881
Practice Address - Fax:612-389-9637
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3977101YP2500X
101YM0800X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1326728379OtherBLUE CIRCLE ART THERAPY LLC