Provider Demographics
NPI:1184218299
Name:HOPEFUL HIPO WELLNESS THERAPY
Entity Type:Organization
Organization Name:HOPEFUL HIPO WELLNESS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPOLITO KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:763-528-0107
Mailing Address - Street 1:12061 NOON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-9796
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18205 45TH AVE N STE A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4594
Practice Address - Country:US
Practice Address - Phone:763-528-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health