| Wild & Free Counseling | |
|
1250 Moore Lake Dr E Fridley MN 55432-5134 | |
| (763) 244-6516 | |
| Not Available |
| Full Name | Wild & Free Counseling |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1250 Moore Lake Dr E, Fridley, Minnesota |
| Authorized Official Name and Position | Camille Jensen (OWNER) |
| Authorized Official Contact | 7632446516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild & Free Counseling 1250 Moore Lake Dr E Ste 205c Fridley MN 55432-5176 Ph: (763) 244-6516 | Wild & Free Counseling 1250 Moore Lake Dr E Fridley MN 55432-5134 Ph: (763) 244-6516 |
| NPI Number | 1689454951 |
|---|---|
| Provider Enumeration Date | 10/03/2023 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Medicare PECOS PAC ID | 6709319072 |
|---|---|
| Medicare Enrollment ID | O20241024002207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689454951 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Camille Jensen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174277727 PECOS PAC ID: 9234662503 Enrollment ID: I20241024002376 |
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