| Wilson Ridge Llc | |
|
1884 Mahogany St Mora MN 55051-7111 | |
| (763) 567-3875 | |
| Not Available |
| Full Name | Wilson Ridge Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1884 Mahogany St, Mora, Minnesota |
| Authorized Official Name and Position | Autumn Wilson (CLINICAL COUNSELOR) |
| Authorized Official Contact | 7635673875 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Ridge Llc 7145 375th Ave Nw Dalbo MN 55017-8403 Ph: (763) 567-3877 | Wilson Ridge Llc 1884 Mahogany St Mora MN 55051-7111 Ph: (763) 567-3875 |
| NPI Number | 1427913649 |
|---|---|
| Provider Enumeration Date | 12/19/2025 |
| Last Update Date | 12/19/2025 |
| Certification Date | 12/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427913649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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