Organization
WISHING WELL THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRANDA JOY AULIE MSW, LICSW (OWNER, THERAPIST)
(218) 851-1450
Entity
Organization
Contact information
Practice address
7760 EXCELSIOR RD STE 104, BAXTER, MN 56425-9768
(218) 851-1450
Mailing address
7760 EXCELSIOR RD STE 104, BAXTER, MN 56425-9768
(218) 851-1450
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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