Organization
HEADWATERS MENTAL HEALTH, LTD.
Active
Organization
HEADWATERS MENTAL HEALTH, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILLIAN CHMIEL LICSW (OWNER)
(612) 759-8934
Entity
Organization
Contact information
Practice address
1614 HARMON PL STE 301, MINNEAPOLIS, MN 55403-1965
(612) 470-7055
Mailing address
PO BOX 8147, SAINT PAUL, MN 55108-0147
(612) 759-8934
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770140311
NPI
—
Enumeration date
04/01/2024
Last updated
04/01/2024
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