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General NPI Number Information
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NPI Number | 1053159277
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Entity Type | Organization
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Legal Business Name | THE HEALING NEST, LLC
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Dates
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Enumeration Date | 07/20/2024
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Last Update Date | 07/20/2024
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Provider Practice Location Address
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Address Line | 110 2ND ST S STE 227
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City | WAITE PARK
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State | MN
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Zip | 56387-1312
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Country | US
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Telephone | 320-204-2980
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Fax |
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Provider Business Mailing Address
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Address Line | 11 FAIRFIELD LN
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City | SAINT CLOUD
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State | MN
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Zip | 56303-0910
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Country | US
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Telephone | 320-282-1714
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KATHRYN MADDEN KINZER
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Credential | LPCC
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Telephone | 320-204-2980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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