Provider Demographics
NPI:1568033215
Name:GLASSWING COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:GLASSWING COUNSELING AND WELLNESS, LLC
Other - Org Name:GLASSWING COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-787-2212
Mailing Address - Street 1:26330 102ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-8578
Mailing Address - Country:US
Mailing Address - Phone:763-360-4260
Mailing Address - Fax:612-448-0900
Practice Address - Street 1:400 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1865
Practice Address - Country:US
Practice Address - Phone:612-787-2212
Practice Address - Fax:612-448-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty