Wild & Free Counseling

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WILD & FREE COUNSELING

Practice address

1250 Moore Lake Dr E
Fridley, MN 55432-5134

Phone

(763) 244-6516

NPI assigned

Oct 3, 2023

Organization subpart

No

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

Authorized official

Name

Camille Jensen, MA, LPCC, LADCNPI 1174277727

Title

Owner

Phone

(763) 244-6516

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Camille Jensen, MA, LPCC, LADC

  • Professional Counselor
  • Fridley, MN
  • NPI 1174277727
  Medicare reassignment NPD Authorized official
• Tracy Doerr, LPCC/LADC

  • Mental Health Counselor
  • Coon Rapids, MN
  • NPI 1194492025

  Multi-Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1689454951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 205C",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325176",
            "telephone_number": "763-244-6516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325134",
            "telephone_number": "763-244-6516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD & FREE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-244-6516",
        "authorized_official_credential": "MA, LPCC, LADC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Curtis Dean Weyrauch, DDS
• Nicole White, MA, LPCC
• Tera White
• Jeff A Wiens Heinsohn
• Donald Eugene Wiger II, MD
• Wild Recovery LLC
• Wild Recovery LLC
• William Louis Wilkie, DMD
• Ebony Shawntil Williams
• Jeff Williams

• Community/Behavioral Health Agency in Fridley, MN
• Providers in Fridley, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.