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General NPI Number Information
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NPI Number | 1508747486
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Entity Type | Organization
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Legal Business Name | TRAVELING LIGHT PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 13040 KINGWOOD DR
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City | BAXTER
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State | MN
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Zip | 56425-8382
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Country | US
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Telephone | 218-454-0499
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Fax |
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Provider Business Mailing Address
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Address Line | 13040 KINGWOOD DR
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City | BAXTER
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State | MN
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Zip | 56425-8382
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Country | US
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Telephone | 218-454-0499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN DOUCETTE
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Credential |
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Telephone | 218-851-4102
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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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