1568033215 NPI number — GLASSWING COUNSELING AND WELLNESS

Table of content: (NPI 1568033215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568033215 NPI number — GLASSWING COUNSELING AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLASSWING COUNSELING AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568033215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26330 102ND ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZIMMERMAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55398-8578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-360-4260
Provider Business Mailing Address Fax Number:
612-448-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55371-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-787-2212
Provider Business Practice Location Address Fax Number:
612-448-0900
Provider Enumeration Date:
07/05/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAREY
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-787-2212

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)