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General NPI Number Information
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NPI Number | 1659269827
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Entity Type | Organization
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Legal Business Name | HIDDEN PINES MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 28752 HIDDEN POINT TRL
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-5819
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Country | US
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Telephone | 218-750-0922
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Fax |
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Provider Business Mailing Address
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Address Line | 28752 HIDDEN POINT TRL
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-5819
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Country | US
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Telephone | 218-750-0922
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SOLE MEMBER
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Name | JESSICA JOYCE COLTER
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Credential | MSW, LICSW
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Telephone | 218-750-0922
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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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