NPI Code Detail JSON Logo

1427827054 NPI number — WISHING WELL THERAPY SERVICES

NPI Number: 1427827054
Health Care Provider/Practitioner: WISHING WELL THERAPY SERVICES

Information about “1427827054” NPI (WISHING WELL THERAPY SERVICES) exists in 1427827054 in HTML format HTML  |  1427827054 in plain Text format TXT  |  1427827054 in PDF (Portable Document Format) PDF  |  1427827054 in an XML format XML  formats.

NPI Number : 1427827054 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1427827054",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WISHING WELL THERAPY SERVICES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7760 EXCELSIOR RD STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BAXTER",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56425-9768",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-851-1450",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7760 EXCELSIOR RD STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAXTER",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56425-9768",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-851-1450",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/22/2023",
    "LastUpdateDate": "12/22/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AULIE",
    "AuthorizedOfficialFirstName": "MIRANDA",
    "AuthorizedOfficialMiddleName": "JOY",
    "AuthorizedOfficialTitle": "OWNER, THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSW, LICSW",
    "AuthorizedOfficialTelephoneNumber": "218-851-1450",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0850X",
        "TaxonomyName": "Adult Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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