Provider Demographics
NPI:1215128707
Name:DANGIE WELLNESS SERVICES P.A.
Entity type:Organization
Organization Name:DANGIE WELLNESS SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARRS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-202-9085
Mailing Address - Street 1:6347 UPLAND LANE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4005
Mailing Address - Country:US
Mailing Address - Phone:612-202-9085
Mailing Address - Fax:763-422-8283
Practice Address - Street 1:6347 UPLAND LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4005
Practice Address - Country:US
Practice Address - Phone:612-202-9085
Practice Address - Fax:763-422-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN215536200Medicaid