Healthcare Provider Details

I. General information

NPI: 1467324459
Provider Name (Legal Business Name): CLEARWATER MENTAL HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W US HIGHWAY 2 STE C
GRAND RAPIDS MN
55744-4733
US

IV. Provider business mailing address

34758 W DEER LAKE RD
DEER RIVER MN
56636-3119
US

V. Phone/Fax

Practice location:
  • Phone: 218-297-5866
  • Fax:
Mailing address:
  • Phone: 218-297-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ABBY LARSON
Title or Position: OWNER
Credential: PMHNP
Phone: 651-260-0761