MEDICARE: THE HEALING NEST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053159277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALING NEST, LLC

Provider Business Mailing Address
First Line	:	11 FAIRFIELD LN
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-0910
Country	:	US
Telephone Number	:	320-282-1714
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 2ND ST S STE 227
Second Line	:
City	:	WAITE PARK
State	:	MN
Zip	:	56387-1312
Country	:	US
Telephone Number	:	320-204-2980
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	KATHRYN MADDEN KINZER
Credential	:	LPCC
Telephone Number	:	320-204-2980

Provider Enumeration Date	:	07/20/2024
Last Update Date	:	07/20/2024

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Directions to “THE HEALING NEST, LLC ” Practice Location

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