Provider Demographics
NPI:1275320228
Name:REWILDING THERAPY PLLC
Entity type:Organization
Organization Name:REWILDING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:218-790-3785
Mailing Address - Street 1:815 37TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5524
Mailing Address - Country:US
Mailing Address - Phone:701-471-7092
Mailing Address - Fax:701-401-0267
Practice Address - Street 1:815 37TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5524
Practice Address - Country:US
Practice Address - Phone:701-471-7092
Practice Address - Fax:701-401-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty