# KIND WATERS THERAPY & WELLNESS. PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447852637
- **Authorized official:** ELISE AILEEN SMITH (HIPAA CREDENTIALING SPECIALIST)
- **Authorized official phone:** (952) 213-4114

## Contact information

- **Practice address:** 3557 33 AVE S, MINNEAPOLIS, MN 55406
- **Practice address phone:** (612) 599-9488
- **Practice address fax:** (952) 213-4117
- **Mailing address:** 3557 33 AVE S, MINNEAPOLIS, MN 55406
- **Mailing address phone:** (612) 599-9488
- **Mailing address fax:** (952) 213-4117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 11/12/2020
- **Last updated:** 11/12/2020