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General NPI Number Information
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NPI Number | 1467244962
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Entity Type | Organization
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Legal Business Name | WILD HOPE PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1509 27TH AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-3034
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Country | US
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Telephone | 612-389-9266
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Fax | 612-453-0725
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Provider Business Mailing Address
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Address Line | 1509 27TH AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-3034
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Country | US
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Telephone | 612-389-9266
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Fax | 612-453-0725
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. NORA HALVERSON
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Credential | PHD, LP
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Telephone | 612-389-9266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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