Provider Demographics
NPI:1972474880
Name:WAVELENGTHS NW LLC
Entity type:Organization
Organization Name:WAVELENGTHS NW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-484-6566
Mailing Address - Street 1:321 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5417
Mailing Address - Country:US
Mailing Address - Phone:206-484-6566
Mailing Address - Fax:
Practice Address - Street 1:321 W 48TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5417
Practice Address - Country:US
Practice Address - Phone:541-801-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)