MEDICARE: WILDBEING COUNSELING 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750236949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDBEING COUNSELING LLC

Provider Business Mailing Address
First Line	:	1186 BURKE AVE W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-5963
Country	:	US
Telephone Number	:	631-682-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1186 BURKE AVE W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-5963
Country	:	US
Telephone Number	:	631-682-8411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MALLAIGH MCGINLEY
Credential	:
Telephone Number	:	631-682-8411

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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