Provider Demographics
NPI:1861038515
Name:MANDY WANNARKA, LICSW INC
Entity Type:Organization
Organization Name:MANDY WANNARKA, LICSW INC
Other - Org Name:MINDFUL WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANNARKA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, PMH-C
Authorized Official - Phone:612-309-2691
Mailing Address - Street 1:199 COON RAPIDS BLVD NW STE 208
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5860
Mailing Address - Country:US
Mailing Address - Phone:612-440-1899
Mailing Address - Fax:612-500-4499
Practice Address - Street 1:199 COON RAPIDS BLVD NW STE 208
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5860
Practice Address - Country:US
Practice Address - Phone:612-440-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty