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 | 103TC2200X, 103TC0700X |
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 |
