=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841112000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHENUTRITION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 832 TOWN ROAD 136
-----------------------------------------------------
City | BAUDETTE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56623-9220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-390-8797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 832 TOWN ROAD 136
-----------------------------------------------------
City | BAUDETTE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56623-9220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-390-8797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTIE LYNN HILLS
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 218-390-8797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------