Provider Demographics
NPI:1013376961
Name:PARASOL WELLNESS COLLABORATIVE
Entity Type:Organization
Organization Name:PARASOL WELLNESS COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-355-4749
Mailing Address - Street 1:9201 QUADAY AVE NE STE 205
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6604
Mailing Address - Country:US
Mailing Address - Phone:763-703-6962
Mailing Address - Fax:
Practice Address - Street 1:9201 QUADAY AVE NE STE 205
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6604
Practice Address - Country:US
Practice Address - Phone:763-703-6962
Practice Address - Fax:651-222-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MN2506261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty