| Wild Tree Psychotherapy, Llc | |
|
1061 Grand Ave Saint Paul MN 55105-3002 | |
| (763) 212-4920 | |
| Not Available |
| Full Name | Wild Tree Psychotherapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1061 Grand Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Lauren Robbins (OWNER) |
| Authorized Official Contact | 6129652622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Tree Psychotherapy, Llc 1061 Grand Ave Saint Paul MN 55105-3002 Ph: (763) 212-4920 | Wild Tree Psychotherapy, Llc 1061 Grand Ave Saint Paul MN 55105-3002 Ph: (763) 212-4920 |
| NPI Number | 1528451408 |
|---|---|
| Provider Enumeration Date | 03/16/2015 |
| Last Update Date | 03/16/2015 |
| Medicare PECOS PAC ID | 8426408881 |
|---|---|
| Medicare Enrollment ID | O20231227001431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528451408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 303202 (Minnesota) | Secondary |
| 251S00000X | Community/behavioral Health | 1287 (Minnesota) | Primary |
| Provider Name | Abbie Marie Vander Maten |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992329965 PECOS PAC ID: 2961866769 Enrollment ID: I20230913000108 |
| Provider Name | Lauren A Robbins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962824664 PECOS PAC ID: 9335599794 Enrollment ID: I20231227001529 |
| Provider Name | Annie Marie Baker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740706712 PECOS PAC ID: 5294186698 Enrollment ID: I20240110002749 |
| Provider Name | Katrina Rude |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891186847 PECOS PAC ID: 7416308622 Enrollment ID: I20240111002129 |
| Provider Name | Sara Nicole Pogue |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659928125 PECOS PAC ID: 4082042163 Enrollment ID: I20240111002292 |
| Provider Name | Stacia Jacobson-gray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457658981 PECOS PAC ID: 5092166215 Enrollment ID: I20240111002420 |
| Provider Name | Emma Doran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760256994 PECOS PAC ID: 9335590553 Enrollment ID: I20240111002512 |
| Provider Name | Amber Rene Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912425737 PECOS PAC ID: 1658722871 Enrollment ID: I20240111002724 |
| Provider Name | Elena Faith Walker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417396409 PECOS PAC ID: 4284085416 Enrollment ID: I20240111002815 |
| Provider Name | Kristin Southworth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962040469 PECOS PAC ID: 9638520745 Enrollment ID: I20240112001017 |
| Provider Name | Carly Jarvinen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861800500 PECOS PAC ID: 7517318694 Enrollment ID: I20240112003313 |
| Provider Name | Jenna A Jovellana |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225558067 PECOS PAC ID: 3274984356 Enrollment ID: I20240112003572 |
| Provider Name | Lauren Andrea Maccoux Kizaur |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548721079 PECOS PAC ID: 7810349859 Enrollment ID: I20240116001628 |
| Provider Name | Keith Warren Munson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1306420310 PECOS PAC ID: 0345692166 Enrollment ID: I20240117003474 |
| Provider Name | Corrine Ann Poole |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992295059 PECOS PAC ID: 7517310725 Enrollment ID: I20240124001420 |
| Provider Name | Kelly Ciapetta |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417424185 PECOS PAC ID: 5092158279 Enrollment ID: I20240205001701 |
| Provider Name | Kirby Kaczor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003679234 PECOS PAC ID: 7911341102 Enrollment ID: I20240215001691 |
| Provider Name | Mollie Jean Kohler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487309753 PECOS PAC ID: 5193160133 Enrollment ID: I20240229000483 |
| Provider Name | Jessica Magarite Pusch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902422959 PECOS PAC ID: 4082059779 Enrollment ID: I20240305000074 |
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