Kristin Southworth

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2296 Issued in MN

Practice address

18205 45TH Ave N Ste C
Plymouth, MN 55446-4594

Phone

(651) 478-4099

NPI assigned

Dec 16, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wild Tree Psychotherapy, LLC

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1528451408
  NPD
• Sarah C. Chambers, P.a.

  • Health Service Clinic/Center
  • Saint Paul, MN
  • NPI 1942358379
  NPD (past)

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1962040469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "868 CARROLL AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551045411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18205 45TH AVE N STE C",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464594",
            "telephone_number": "651-478-4099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2724 University Ave SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554143210",
            "country_code": "US",
            "telephone_number": "612-299-1090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHWORTH",
        "first_name": "KRISTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-16",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "2296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Robert Sorensen, DDS
• Soteria Family Health Center
• Soundpoint Audiology
• South Lake Clinic, PA
• Nickolas C Southwick, CRNA
• Kelly M Spanier
• Anthony Spano, M.D.
• Kelsey Speaks, CF-SLP
• Kristin Lynn Spencer, CNP
• Stephanie Demarais Sperl, MSN, APRN, CPNP-PC

• Mental Health Counselor in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.