Provider Demographics
NPI:1235797853
Name:WILD MEADOWS COUNSELING PLLC
Entity Type:Organization
Organization Name:WILD MEADOWS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESNESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-541-2424
Mailing Address - Street 1:239 CHERRY HILL ALCOVE
Mailing Address - Street 2:
Mailing Address - City:HAMEL
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 CHERRY HILL ALCOVE
Practice Address - Street 2:
Practice Address - City:HAMEL
Practice Address - State:MN
Practice Address - Zip Code:55340-9333
Practice Address - Country:US
Practice Address - Phone:715-541-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty