Provider Demographics
NPI:1649031709
Name:ENVISION WELLBEING
Entity type:Organization
Organization Name:ENVISION WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARAGSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMATAR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-310-9145
Mailing Address - Street 1:10260 BLEEKER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6904
Mailing Address - Country:US
Mailing Address - Phone:320-310-9145
Mailing Address - Fax:
Practice Address - Street 1:10260 BLEEKER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-6904
Practice Address - Country:US
Practice Address - Phone:320-310-9145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health