| Wild Roots Counseling Llc | |
|
11670 Fountains Dr Ste 278 Maple Grove MN 55369-7195 | |
| (612) 361-7688 | |
| (612) 230-2034 |
| Full Name | Wild Roots Counseling Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11670 Fountains Dr Ste 278, Maple Grove, Minnesota |
| Authorized Official Name and Position | Toni Stone (OWNER/THERAPIST) |
| Authorized Official Contact | 6123617688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Roots Counseling Llc 11670 Fountains Dr Ste 278 Maple Grove MN 55369-7195 Ph: (612) 361-7688 | Wild Roots Counseling Llc 11670 Fountains Dr Ste 278 Maple Grove MN 55369-7195 Ph: (612) 361-7688 |
| NPI Number | 1104673151 |
|---|---|
| Provider Enumeration Date | 05/06/2024 |
| Last Update Date | 01/06/2025 |
| Certification Date | 01/06/2025 |
| Medicare PECOS PAC ID | 8123565314 |
|---|---|
| Medicare Enrollment ID | O20240806001568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104673151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Toni Marie Stone |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689048399 PECOS PAC ID: 2062862188 Enrollment ID: I20240102000803 |
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