Wild Acres Counseling, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1286 Issued in MN

Legal business name

WILD ACRES COUNSELING, LLC

Practice address

15489 45TH St S
Alton, MN 55001

Phone

(651) 315-5254

NPI assigned

Oct 11, 2014

Last updated

Jun 17, 2020By 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

Mrs. Kathy Lyn Boisjoli, MA, LPCCNPI 1487991212

Title

Owner / President

Phone

(651) 315-5254

Specialties & licenses 1

Addresses

Tax ID family

Healing Lives LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Healing Lives, LLC

  • Mental Health Counselor
  • Edina, MN
  • NPI 1932575891
  NPD tax ID

Locations

Practitioners 4

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.

• Kathy Lyn Boisjoli, MA, LPCC

  • Mental Health Counselor
  • Edina, MN
  • NPI 1487991212
  Authorized official Same address or phone
• Wyatt Coleman

  • Clinical Social Worker
  • Afton, MN
  • NPI 1164095568
  NPD
• Kelly Kennedy-Johnson, LPCC

  • Mental Health Counselor
  • Afton, MN
  • NPI 1477256428
  NPD
• Corrin Lea Schmidtke, MSW, LICSW

  • Clinical Social Worker
  • Afton, MN
  • NPI 1205519659
  NPD

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

{
    "created_epoch": "1412985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1346644952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15489 45TH ST S",
            "city": "ALTON",
            "state": "MN",
            "postal_code": "55001",
            "telephone_number": "651-315-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15489 45TH ST S",
            "city": "ALTON",
            "state": "MN",
            "postal_code": "55001",
            "telephone_number": "651-315-5254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ACRES COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-11",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "BOISJOLI",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "651-315-5254",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "1286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.