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Contact Information

THE LAKE GROUP LLC
4500 PARK GLEN ROAD #155
SAINT LOUIS PARK, MN55416
 Phone: 612-223-7992
 Fax: 952-928-9774
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Marriage & Family Therapist

106H00000X
 

Nutritionist

133N00000X
 

Professional

101YP2500X
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for THE LAKE GROUP LLC · (Female)

NPI # 1346471232
Status Active
Credentials
Entity Individual
Enumeration date 07/27/2009
Last updated 11/11/2024 - More than a year ago
Sole proprietor 1 Not specified
Identifiers
  • MN Other 5H617PO BLUE CROSS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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