Active NPI
Marie Bourne, LPC
- Professional Counselor
- Saint Cloud, MN
National Provider Identifier
1922463173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 01569
- Practice address
- 4140 Thielman LN
Saint Cloud, MN 56301-7326 - Phone
- (320) 253-5930
- NPI assigned
- Dec 15, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 01569 | MN | Primary |
Addresses
Primary practice location
4140 Thielman LN
Saint Cloud, MN 56301-7326
Mailing address
PO Box 9859
Fargo, ND 58106-9859
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241111000523 | MN | Practitioner - Mental Health Counselor | 1355875501 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01569 | MN | MD | Professional Counselor |
| 1321 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Attacure, LLC | Current | Accepting new patients | |
| Village Family Service Center | Professional | Past | Accepting new patients |
Locations
20 Red River Ave S
Ste 100
Cold Spring, MN 56320
Phone (320) 407-1110
720 8th Ave N
Saint Cloud, MN 56303
Phone (320) 333-9228
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fargo, ND
- NPI 1568492353
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1922463173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9859",
"city": "FARGO",
"state": "ND",
"postal_code": "581069859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4140 THIELMAN LN",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563017326",
"telephone_number": "320-253-5930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURNE",
"first_name": "MARIE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-15",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "01569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.