Healthcare Provider Details

I. General information

NPI: 1609690197
Provider Name (Legal Business Name): NORTHWIND HOLISTIC PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 2ND ST W
PARK RAPIDS MN
56470-1506
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 237
COLORADO SPRINGS CO
80920-5017
US

V. Phone/Fax

Practice location:
  • Phone: 320-500-2040
  • Fax: 320-244-7958
Mailing address:
  • Phone: 320-500-2040
  • Fax: 320-244-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY PITTMAN
Title or Position: OWNER
Credential: DMSC, PA-C
Phone: 320-500-2040