Provider Demographics
NPI:1578331583
Name:FLOURISH WELLNESS COLLABORATIVE
Entity Type:Organization
Organization Name:FLOURISH WELLNESS COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-405-9601
Mailing Address - Street 1:12400 PORTLAND AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6875
Mailing Address - Country:US
Mailing Address - Phone:952-405-9601
Mailing Address - Fax:952-405-9571
Practice Address - Street 1:12400 PORTLAND AVE STE 180
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6875
Practice Address - Country:US
Practice Address - Phone:952-405-9601
Practice Address - Fax:952-405-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty