Provider Demographics
NPI:1346644952
Name:WILD ACRES COUNSELING, LLC
Entity Type:Organization
Organization Name:WILD ACRES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BOISJOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:651-315-5254
Mailing Address - Street 1:15489 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:MN
Mailing Address - Zip Code:55001
Mailing Address - Country:US
Mailing Address - Phone:651-315-5254
Mailing Address - Fax:
Practice Address - Street 1:15489 45TH ST S
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MN
Practice Address - Zip Code:55001
Practice Address - Country:US
Practice Address - Phone:651-315-5254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty