Provider Demographics
NPI:1689421513
Name:RECONNECT COUNSELING LLC
Entity type:Organization
Organization Name:RECONNECT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-910-2406
Mailing Address - Street 1:37904 LEVER ST NE
Mailing Address - Street 2:
Mailing Address - City:STANCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55080-5023
Mailing Address - Country:US
Mailing Address - Phone:651-503-2549
Mailing Address - Fax:
Practice Address - Street 1:4445 77TH ST W STE 201
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5135
Practice Address - Country:US
Practice Address - Phone:763-910-2406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)