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General NPI Number Information
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NPI Number | 1467324459
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Entity Type | Organization
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Legal Business Name | CLEARWATER MENTAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 204 NW 1ST AVE STE 4
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2749
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Country | US
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Telephone | 218-297-5866
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Fax | 218-885-8840
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Provider Business Mailing Address
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Address Line | 204 NW 1ST AVE STE 4
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2749
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABBY LARSON
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Credential | PMHNP
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Telephone | 651-260-0761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 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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