Headwaters Mental Health, LTD.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

HEADWATERS MENTAL HEALTH, LTD.

Practice address

1614 Harmon PL Ste 301
Minneapolis, MN 55403-1965

Phone

(612) 470-7055

NPI assigned

Apr 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jillian Chmiel, LICSWNPI 1770140311

Title

Owner

Phone

(612) 759-8934

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jillian James Chmiel, LGSW

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1770140311
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1699526210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8147",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551080147",
            "telephone_number": "612-759-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 HARMON PL STE 301",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554031965",
            "telephone_number": "612-470-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEADWATERS MENTAL HEALTH, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-03-31",
        "status": "A",
        "authorized_official_last_name": "CHMIEL",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-759-8934",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770140311",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James A Heacock, MS, LMFT
• Head to Toe Chiropractic Clinic, PLLC
• Keith Robert Head
• Headache House Call PLLC
• Headache House Call PLLC
• Headwinds Solutions MN,LLC
• Heal With Me Psychotherapy LLC
• Healing Autism Center
• Healing Care Inc
• Healing Circle Health Services

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.