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KRISTIN SOUTHWORTH
NPI 1962040469
Counselor - Mental Health in Plymouth, MN

Active since December 16, 2019PECOS Enrolled
18205 45TH AVE N STE C, PLYMOUTH, MN 55446(651) 478-4099 Get Directions Write a Review

NPPES record last updated: January 6, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 6, 2023, Dec 16, 2019 (2 updates tracked since 2019).

About Kristin Southworth NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KRISTIN SOUTHWORTH (NPI 1962040469) is an individual mental health provider in Plymouth, Minnesota, licensed in Minnesota (2296) and active in the NPI registry since December 2019. She is enrolled in Medicare PECOS and maintains a secondary practice location in Minneapolis.

NPPES Registry Identity

NPI1962040469
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKRISTIN SOUTHWORTH
Location Address18205 45TH AVE N STE CPlymouth, MN 55446-4594
Mailing Address868 Carroll AveSaint Paul, MN 55104-5411
Phone(651) 478-4099
Sole ProprietorNo
Enumeration DateDecember 16, 2019
Last NPPES UpdateJanuary 6, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 6, 2023
✔ NPI 1962040469 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in MN · 2296
18205 45TH AVE N STE C, Plymouth, MN 55446
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Secondary Practice Location 1

Location 12724 University Ave SEMinneapolis, MN 55414-3210 · Phone (612) 299-1090

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kristin Southworth is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NATALIE BRANDSRUD CNP
Nurse Practitioner (Psychiatric/Mental Health)
18205 45TH AVE N STE C
PLYMOUTH, MN 55446
Hennepin County (763) 400-7828
SCOTT THOMAS STOLTENBERG LMFT
Marriage & Family Therapist
18205 45TH AVE N STE C
PLYMOUTH, MN 55446
Hennepin County (763) 762-6279

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kristin Southworth's NPI number?

The NPI number for Kristin Southworth is 1962040469. It was assigned to this individual provider in the NPPES registry on December 16, 2019.

Where is Kristin Southworth located?

Kristin Southworth practices at 18205 45th Ave N Ste C, Plymouth, MN 55446. The listed phone number is (651) 478-4099.

What is Kristin Southworth's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kristin Southworth enrolled in Medicare?

Yes. Kristin Southworth is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kristin Southworth was last updated on January 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.