Individual provider Active NPI

Reece A. Forrester, MA, LMFT

  • Marriage & Family Therapist
  • Edina, MN
National Provider Identifier
1073799102
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2498 Issued in MN
Practice address
5780 Lincoln Dr Ste 123
Edina, MN 55436-1600
Phone
(952) 592-8114
Fax
(952) 209-6622
NPI assigned
Jan 18, 2008
Last updated
Sep 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X RC00056737 WA
Marriage & Family Therapist 106H00000X 2498 MN Primary

Addresses

Primary practice location

5780 Lincoln Dr Ste 123
Edina, MN 55436-1600

Mailing address

5780 Lincoln Dr Ste 123
Edina, MN 55436-1600
Phone (952) 592-8114

Other practice location 1

3580 Pacific Ave
Tacoma, WA 98418-7915
Phone (253) 798-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240313001512 MN Practitioner - Marriage and Family Therapist 8729452842 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5780 Lincoln Dr
Suite 123
Edina, MN 55436-1600
Phone (952) 836-9674

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
RC00056737WAMDMental Health Counselor
2498MNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ashlee Secord Marriage & Family Therapist CurrentSince Jan 29, 2024 Accepting new patients
Odyssey Counseling LTD CurrentSince Mar 16, 2022 Accepting new patients

Locations

11990 Portland Ave
Burnsville, MN 55337
Phone (612) 439-1100

5780 Lincoln Dr
Ste 123
Saint Louis Park, MN 55436
Phone (952) 592-8114

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1073799102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5780 LINCOLN DR STE 123",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361600",
            "telephone_number": "952-592-8114",
            "fax_number": "952-209-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5780 LINCOLN DR STE 123",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361600",
            "telephone_number": "952-592-8114",
            "fax_number": "952-209-6622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3580 Pacific Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984187915",
            "country_code": "US",
            "telephone_number": "253-798-4500",
            "fax_number": "253-798-4493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORRESTER",
        "first_name": "REECE",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "MA, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-18",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "RC00056737",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.