Organization
CLEARWATERS CROSBY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA KUBISTA LMFT (OWNER)
(218) 585-2052
Entity
Organization
Contact information
Practice address
207 1ST ST NW, CROSBY, MN 56441-1301
(218) 585-2052
Mailing address
15157 LADYSLIPPER LN, DEERWOOD, MN 56444-8918
(218) 585-2058
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093389736
—
MN
05
—
1154711406
—
MN
Enumeration date
05/17/2021
Last updated
09/28/2024
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