Provider Demographics
NPI: | 1780031732 |
---|---|
Name: | SONDER BEHAVIORAL HEALTH & WELLNESS, INC. |
Entity Type: | Organization |
Organization Name: | SONDER BEHAVIORAL HEALTH & WELLNESS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHILPLIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 952-999-6097 |
Mailing Address - Street 1: | 12301 WHITEWATER DR |
Mailing Address - Street 2: | STE 101 |
Mailing Address - City: | MINNETONKA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55343-9447 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-999-6097 |
Mailing Address - Fax: | 952-426-0508 |
Practice Address - Street 1: | 12301 WHITEWATER DR |
Practice Address - Street 2: | STE 101 |
Practice Address - City: | MINNETONKA |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55343-9447 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-999-6097 |
Practice Address - Fax: | 952-426-0508 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-05-19 |
Last Update Date: | 2016-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 101YA0400X, 101YM0800X, 101YP2500X, 103G00000X, 103TC1900X, 1041C0700X, 106H00000X, 2084P0800X, 2084P0804X, 363AM0700X, 363LF0000X, 363LP0808X, 364SP0808X | |
MN | LP4754 | 103TC0700X, 103TC2200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 1780031732 | Medicaid | |
MN | H100311926 | Medicare PIN |