Wild Peace Integrative Wellness PLLC
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Long Lake, MN
NPI 1972449718 · NPPES record last updated Jun 6, 2026
Key facts
- NPI
- 1972449718
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- WILD PEACE INTEGRATIVE WELLNESS PLLC
- Practice address
- 2354 Wayzata Boulevard W.
Suite a
Long Lake, MN 55356 - Phone
- (952) 260-8330
- NPI assigned
- Apr 24, 2026
- Organization subpart
- No
Authorized official
- Name
- Keely Heiser, LICSW
- Title
- Organizer
- Phone
- (952) 260-8330
Practitioners 1
National Provider Directory
Locations
2354 W Wayzata Blvd
Ste A
Long Lake, MN 55356
Phone (952) 260-8330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
2354 Wayzata Boulevard W.
Suite a
Long Lake, MN 55356
Mailing address
2354 W Wayzata Blvd Ste a
Long Lake, MN 55356-2602
Phone (952) 260-8330
Other providers in Long Lake, MN
- Paul John Thinesen
- Tonka Life Center, LTD
- Water'S Edge Dental
- Angela Jean Weber
- West Lake Counseling and Wellness, Inc
- Amy Michelle Willcockson
All providers in Long Lake, MN · Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.