Provider Demographics
NPI:1336208503
Name:WING, DENISE LYNN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:WING
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:763-315-4669
Practice Address - Street 1:7401 METRO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3062
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:612-268-5868
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1812106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1336208503Medicaid
MN1336208503OtherBLUE CROSS BLUE SHIELD
MN1336208503OtherHEALTH PARTNERS
MN2191290OtherCOMPSYCH EAP