Provider Demographics
NPI:1356187470
Name:WANDER WELL COUNSELING, PLLC
Entity type:Organization
Organization Name:WANDER WELL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-503-9110
Mailing Address - Street 1:14 TOBEY RD
Mailing Address - Street 2:STE G UNIT 162
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571
Mailing Address - Country:US
Mailing Address - Phone:508-503-9110
Mailing Address - Fax:508-484-4499
Practice Address - Street 1:37 CRANBERRY FARM RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2279
Practice Address - Country:US
Practice Address - Phone:508-503-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty