Courtney Marie Bagley, M.A. LMFT

Key facts

NPI

1003277286

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

2918 (MN)

Practice address

11549 Lake LN Ste 2
Chisago City, MN 55013-9201

Phone

(651) 257-2733

NPI assigned

Mar 15, 2016

Sex

Female

Sole proprietor

Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Based Therapy Associates Mental Health Counselor · Coon Rapids, MN · NPI 1194762005
  NPD
• Family Based Therapy Associates Community/Behavioral Health Agency · Chisago City, MN · NPI 1891100293
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2020.

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1003277286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11549 LAKE LN STE 2",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139201",
            "telephone_number": "651-257-2733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11549 LAKE LN STE 2",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139201",
            "telephone_number": "651-257-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLEY",
        "first_name": "COURTNEY",
        "middle_name": "MARIE",
        "credential": "M.A. LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-15",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chisago City, MN

• Nancy L Alexis, MD
• Dana Marie Andersen
• Amy Christopherson Anderson, MD
• Revana Emad Awadallah, DMD
• Jessica Ria Babcock, PA-C
• Natasha Barnes, LMFT
• Riley Scott Baumgartner, DDS
• Danielle Kallin Brink, DC
• Susie Joy Brooks
• Chisago County Council for Exceptional Individuals, Inc.

All providers in Chisago City, MN · Marriage & Family Therapist in Minnesota