Kristin Southworth, in Plymouth, MN - Medicare Counselor Provider

Kristin Southworth, is a medicare enrolled "Counselor - Mental Health" provider in Plymouth, Minnesota. Her current practice location is 18205 45th Ave N Ste C, Plymouth, Minnesota. You can reach out to her office (for appointments etc.) via phone at (651) 478-4099.

Kristin Southworth is licensed to practice in Minnesota (license number 2296) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1962040469.

Contact Information

	Kristin Southworth,
	18205 45th Ave N Ste C, Plymouth, MN 55446-4594
	(651) 478-4099
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Kristin Southworth
Gender	Female
Speciality	Counselor - Mental Health
Location	18205 45th Ave N Ste C, Plymouth, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1962040469
Provider Enumeration Date: 12/16/2019
Last Update Date: 01/06/2023

Medicare PECOS Information:

PECOS PAC ID: 9638520745
Enrollment ID: I20240112001017

Medical Identifiers

Medical identifiers for Kristin Southworth such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1962040469	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YM0800X	Counselor - Mental Health	2296 (Minnesota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kristin Southworth allows following entities to bill medicare on her behalf.

Entity Name	Wild Tree Psychotherapy Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1528451408 PECOS PAC ID: 8426408881 Enrollment ID: O20231227001431

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kristin Southworth is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kristin Southworth, 868 Carroll Ave, Saint Paul, MN 55104-5411 Ph: () -	Kristin Southworth, 18205 45th Ave N Ste C, Plymouth, MN 55446-4594 Ph: (651) 478-4099

Reviews and Comments

Counselor in Plymouth, MN

Jesse Inderlee, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 13895 Industrial Park Blvd, Plymouth, MN 55441 Phone: 763-559-5677
Lauris J Prinsen, L.A.D.C. Counselor Medicare: Not Enrolled in Medicare Practice Location: 12805 Highway 55, Suite 211, Plymouth, MN 55441 Phone: 763-550-9005 Fax: 763-559-2118
Jessica Sklar, MA, LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 19095 51st Pl N, Plymouth, MN 55446 Phone: 952-212-1330
Luke Morken, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10000 Hwy 55 Ste 300, Plymouth, MN 55441 Phone: 763-412-0722
Emily Cross, MA, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 115 Forestview Ln N, Plymouth, MN 55441 Phone: 763-546-8008
Mrs. Melody Joy Richards, MA, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 13210 45th Ave North, Plymouth, MN 55442 Phone: 612-616-0224 Fax: 612-616-0224
Sada Kathryn Puckett, LPCC, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 2415 Annapolis Ln N Ste 130, Plymouth, MN 55441 Phone: 763-220-0218

Kristin Southworth, - Medicare Counselor in Plymouth, MN