Healthcare Provider Details

I. General information

NPI: 1053159277
Provider Name (Legal Business Name): THE HEALING NEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 2ND ST S STE 227
WAITE PARK MN
56387-1312
US

IV. Provider business mailing address

11 FAIRFIELD LN
SAINT CLOUD MN
56303-0910
US

V. Phone/Fax

Practice location:
  • Phone: 320-204-2980
  • Fax:
Mailing address:
  • Phone: 320-282-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN MADDEN KINZER
Title or Position: THERAPIST/OWNER
Credential: LPCC
Phone: 320-204-2980