Woodhaven Wellness LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WOODHAVEN WELLNESS LLC

Practice address

30 1St Ave NE
Buffalo, MN 55313-1515

Phone

(763) 478-7395

NPI assigned

Aug 13, 2020

Last updated

Apr 1, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary G. Mattison-Wynn, PSY.D.NPI 1649202755

Title

Ceo

Phone

(763) 478-7395

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary G Mattison-Wynn, PSY D LP

  • Psychologist
  • Buffalo, MN
  • NPI 1649202755
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1124639190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 CARRIAGE DR",
            "city": "HAMEL",
            "state": "MN",
            "postal_code": "553409597",
            "telephone_number": "763-478-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 1ST AVE NE",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131515",
            "telephone_number": "763-478-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODHAVEN WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "MATTISON-WYNN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-478-7395",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "woodhavenwellness14@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3000 Carriage Dr",
            "city": "Hamel",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553409597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "woodhavenwellness14@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3000 Carriage Dr",
            "city": "Hamel",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553409597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "woodhavenwellness14@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3000 Carriage Dr",
            "city": "Hamel",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553409597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bradley Jerome Winterhalter
• Heidi Wolak-Faber, SLP
• Jessica Wolney
• Victorine Alma Ntembo Wongbi, PHARMD
• Mary Wonsehleay
• Jill C Woodward, MA LPC
• Ashley Woolison, SLP
• Wright County (Wright County Public Health)
• Wright County (Wright County Health & Human Services)
• Wright County Chiropractic

• Mental Health Clinic/Center (Including Community Mental Health Center) in Buffalo, MN
• Providers in Buffalo, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.