Provider Demographics
NPI:1457861544
Name:WELLNESS INITIATIVES, LLC
Entity Type:Organization
Organization Name:WELLNESS INITIATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:BOY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW LADC SEP
Authorized Official - Phone:952-406-1090
Mailing Address - Street 1:11900 WAYZATA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2053
Mailing Address - Country:US
Mailing Address - Phone:952-406-1090
Mailing Address - Fax:952-224-5996
Practice Address - Street 1:11900 WAYZATA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2053
Practice Address - Country:US
Practice Address - Phone:952-406-1090
Practice Address - Fax:952-224-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16880261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health