Healthcare Provider Details

I. General information

NPI: 1386953974
Provider Name (Legal Business Name): WATER'S EDGE PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 SIBLEY MEMORIAL HWY
MENDOTA MN
55150-1414
US

IV. Provider business mailing address

675 CHEYENNE LN
MENDOTA HEIGHTS MN
55120-1687
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-0768
  • Fax:
Mailing address:
  • Phone: 612-293-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18780
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATRIN CHRISTENSEN-COWAN
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 612-293-0768