Provider Demographics
NPI:1659245330
Name:WILD & FREE RECOVERY
Entity type:Organization
Organization Name:WILD & FREE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE/ALVIN
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADC
Authorized Official - Phone:612-201-2280
Mailing Address - Street 1:1250 MOORE LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5134
Mailing Address - Country:US
Mailing Address - Phone:612-201-2280
Mailing Address - Fax:612-465-2096
Practice Address - Street 1:1250 MOORE LAKE DR E STE 210
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5135
Practice Address - Country:US
Practice Address - Phone:612-201-2280
Practice Address - Fax:612-465-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health