Provider Demographics
NPI:1598592859
Name:IDEAWELL LLC
Entity type:Organization
Organization Name:IDEAWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-200-4321
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3106 164TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-2416
Practice Address - Country:US
Practice Address - Phone:763-200-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty