Provider Demographics
NPI:1407688971
Name:WILLFUL PSYCHOTHERAPY & CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:WILLFUL PSYCHOTHERAPY & CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:651-434-9312
Mailing Address - Street 1:629 UPTON AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3527
Mailing Address - Country:US
Mailing Address - Phone:651-434-9312
Mailing Address - Fax:
Practice Address - Street 1:1024 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5414
Practice Address - Country:US
Practice Address - Phone:651-434-9312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty