WATERSHED PSYCHOLOGICAL SERVICES (NPI# 1952763351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952763351 |
| Entity Type | Organization |
| Organization Name | WATERSHED PSYCHOLOGICAL SERVICES |
| Practice Address |
4255 Pheasant Ridge Drive Suite 412 Blaine MN 55391 |
| Mailing Address |
4255 Pheasant Ridge Dr Ne Suite 412 Blaine MN 55449-4537 |
| Practice Telephone | 7633176222 |
| Practice Fax Number | 7633073835 |
| Mailing Telephone | 7633176222 |
| Mailing Fax Number | 7633073835 |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-08-08 |
| Authorized Official Name | MEGAN JEAN BOOM SHEDLOCK (CO-OWNER) |
| Authorized Official Telephone | 3202664535 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
4255 PHEASANT RIDGE DRIVE SUITE 412 |
| City | BLAINE |
| State | MN |
| Zip Code | 55391 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386456 | Alexandra Lloyd Conroy | Counselor | 3227 Lake Shore Boulevard, Minnetonka, MN 55391 | 2020-11-07 |
| 1417579178 | Kate Anne Schroeder | Behavioral Analyst | 901 Twelve Oaks Center Drive Suite 934, Wayzata, MN 55391 | 2020-05-15 |
| 1467940478 | Tyler Michael Knutson | Chiropractor | 1421 E Wayzata Blvd, Wayzata, MN 55391 | 2018-04-25 |
| 1427552025 | Emma Nadler, L.L.C. | Counselor | 700 Twelve Oaks Center Dr. #263, Wayzata, MN 55391 | 2018-03-20 |
| 1730687757 | Global Home Care Inc | Home Health | 1001 Twelve Oaks Center Drive, Suite 1018, Wayzata, MN 55391 | 2018-01-24 |
| 1205362472 | Oraphanh Vongpheth Smith | Registered Nurse | 801 Twelve Oaks Center Drive, Suite 822, Wayzata, MN 55391 | 2017-05-10 |
| 1386189272 | Wayzata Endodontics, P.a. | Dentist | 101 Lake Street West, Suite 100, Wayzata, MN 55391 | 2016-12-30 |
| 1477923571 | Robert J. Floren | Marriage & Family Therapist | 801 Twelve Oaks Center Dr Ste 816a, Wayzata, MN 55391 | 2015-10-01 |
| 1194101055 | Bruce Martinson Family & Cosmetic Dentistry | Dentist | 317 E Wayzata Blvd, Wayzata, MN 55391 | 2015-08-03 |
| 1386083160 | Wayzata Bay Senior Housing, Inc. | Skilled Nursing Facility | 100 Promenade Ave, Wayzata, MN 55391 | 2013-06-14 |
| Find all providers in zip 55391 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972143345 | Seeds for Change Counseling, LLC | Clinic/Center | 4255 Pheasant Ridge Dr Ne Ste 412, Blaine, MN 55449-5066 | 2020-01-13 |
| 1336628478 | Vlw LLC | Clinic/Center | 4255 Pheasant Ridge Dr Ne Ste 412, Blaine, MN 55449-5066 | 2018-08-09 |
| 1457868820 | Center for Mental Health and Wellness, LLC | Clinic/Center | 11855 Ulysses St Ne Ste 40, Blaine, MN 55434-3947 | 2018-01-05 |
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|---|---|---|---|---|
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| 1740880764 | East Metro Trauma and Recovery LLC | Clinic/Center | 4116 Hoffman Rd, White Bear Lake, MN 55110-3708 | 2020-10-28 |
| 1851991160 | Gratia Counseling & Consulting, LLC | Clinic/Center | 2705 Bunker Lake Blvd Nw Ste 103, Andover, MN 55304-3786 | 2020-10-27 |
| 1508465147 | Piece of Mind Counseling Services, Pllc | Clinic/Center | 1122 Bemidji Ave N, Bemidji, MN 56601-2833 | 2020-10-24 |
| 1205433984 | Hopebridge Life Skills Center | Clinic/Center | 3617 E Lake St, Minneapolis, MN 55406-2148 | 2020-10-05 |
| 1275149007 | Clarity Counseling Services Pllc | Clinic/Center | 521 W Highway 2, Cohasset, MN 55721-2300 | 2020-09-17 |
| 1720693146 | Serene Therapy and Counseling Services LLC | Clinic/Center | 777 Berry St Apt 400b, Saint Paul, MN 55114-4006 | 2020-09-11 |
| 1427662592 | Threesixty, LLC | Clinic/Center | 4960 Miller Trunk Hwy # 600-b, Hermantown, MN 55811-1891 | 2020-09-04 |
| 1124639190 | Woodhaven Wellness | Clinic/Center | 3000 Carriage Dr, Hamel, MN 55340-9597 | 2020-08-13 |
| 1245840735 | Kalina Counseling Services | Clinic/Center | 120 7th St Unit 101, Two Harbors, MN 55616-1563 | 2020-08-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.