| Wildwood Mental Health Llc | |
|
204 Nw 1st Ave Ste 4 Grand Rapids MN 55744-2749 | |
| (218) 301-6278 | |
| Not Available |
| Full Name | Wildwood Mental Health Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 204 Nw 1st Ave Ste 4, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Tabbatha Litchke Herdman (LPCC) |
| Authorized Official Contact | 2183016278 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildwood Mental Health Llc 204 Nw 1st Ave Ste 4 Grand Rapids MN 55744-2749 Ph: () - | Wildwood Mental Health Llc 204 Nw 1st Ave Ste 4 Grand Rapids MN 55744-2749 Ph: (218) 301-6278 |
| NPI Number | 1811613599 |
|---|---|
| Provider Enumeration Date | 10/14/2022 |
| Last Update Date | 01/12/2023 |
| Certification Date | 01/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811613599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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