Healthcare Provider Details

I. General information

NPI: 1003738303
Provider Name (Legal Business Name): MENTAL HEALTH MATTERS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 SUNSET BOULEVARD
HAWLEY MN
56549-0206
US

IV. Provider business mailing address

PO BOX 206
HAWLEY MN
56549-0206
US

V. Phone/Fax

Practice location:
  • Phone: 218-206-6252
  • Fax:
Mailing address:
  • Phone: 218-206-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLIE MARIE LARSON
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 218-206-6252