Provider Demographics
NPI:1841448115
Name:WELLBEING COLLABORATIVE, LTD.
Entity type:Organization
Organization Name:WELLBEING COLLABORATIVE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-605-6575
Mailing Address - Street 1:1170 15TH AVE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2589
Mailing Address - Country:US
Mailing Address - Phone:612-605-6575
Mailing Address - Fax:
Practice Address - Street 1:1170 15TH AVE SE
Practice Address - Street 2:SUITE 210
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2589
Practice Address - Country:US
Practice Address - Phone:612-605-6575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN173671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty