Provider Demographics
NPI:1386953974
Name:WATER'S EDGE PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:WATER'S EDGE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN-COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-293-0768
Mailing Address - Street 1:675 CHEYENNE LN
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1687
Mailing Address - Country:US
Mailing Address - Phone:612-293-0768
Mailing Address - Fax:
Practice Address - Street 1:750 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-3765
Practice Address - Country:US
Practice Address - Phone:612-293-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN187801041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty