Healthcare Provider Details

I. General information

NPI: 1841112000
Provider Name (Legal Business Name): PSYCHENUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 TOWN ROAD 136
BAUDETTE MN
56623-9220
US

IV. Provider business mailing address

832 TOWN ROAD 136
BAUDETTE MN
56623-9220
US

V. Phone/Fax

Practice location:
  • Phone: 218-390-8797
  • Fax:
Mailing address:
  • Phone: 218-390-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE LYNN HILLS
Title or Position: OWNER
Credential: LPCC
Phone: 218-390-8797