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NPI Code Detail

MEDICARE: WILD HOPE PSYCHOLOGICAL SERVICES LLC

MEDICARE: WILD HOPE PSYCHOLOGICAL SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1467244962
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILD HOPE PSYCHOLOGICAL SERVICES LLC
Provider Business Mailing Address
First Line : 1509 27TH AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3034
Country : US
Telephone Number : 612-389-9266
Fax Number : 612-453-0725
Provider Business Practice Location Address
First Line : 1509 27TH AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-3034
Country : US
Telephone Number : 612-389-9266
Fax Number : 612-453-0725
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. NORA HALVERSON
Credential : PHD, LP
Telephone Number : 612-389-9266
Provider Enumeration Date : 05/20/2025
Last Update Date : 07/10/2025

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