Healthcare Provider Details

I. General information

NPI: 1326875428
Provider Name (Legal Business Name): WELLSONG COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/14/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 CHICAGO AVE STE 1C
MINNEAPOLIS MN
55407-4181
US

IV. Provider business mailing address

PO BOX 17013
MINNEAPOLIS MN
55417-0013
US

V. Phone/Fax

Practice location:
  • Phone: 612-470-6511
  • Fax:
Mailing address:
  • Phone: 612-470-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY KAMEL
Title or Position: OWNER
Credential: LICSW
Phone: 612-470-6511