Healthcare Provider Details

I. General information

NPI: 1497366611
Provider Name (Legal Business Name): HARVEST MOON MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5204 KLINKER RD
SILVER BAY MN
55614-3640
US

IV. Provider business mailing address

5204 KLINKER RD
SILVER BAY MN
55614-3640
US

V. Phone/Fax

Practice location:
  • Phone: 218-270-4449
  • Fax:
Mailing address:
  • Phone: 218-251-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CORRIE RENEE EHRBRIGHT
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 218-270-4449