# BOURNE WELLNESS CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801731492
- **Authorized official:** SHADLYN C BOURNE (OWNER)
- **Authorized official phone:** (763) 614-6393

## Contact information

- **Practice address:** 4007 65TH AVE N, BROOKLYN CENTER, MN 55429
- **Practice address phone:** (763) 614-6393
- **Mailing address:** 4007 65TH AVE N, BROOKLYN CENTER, MN 55429-2158
- **Mailing address phone:** (763) 614-6393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2026
- **Last updated:** 04/21/2026