|
| |
|
14093 Commerce Ave Ne Prior Lake MN 55372-1495 | |
| (952) 440-3100 | |
| (952) 440-3100 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 14093 Commerce Ave Ne, Prior Lake, Minnesota |
| Authorized Official Name and Position | Tracy Lee Kling Kotval (DIRECTOR) |
| Authorized Official Contact | 9524403100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14093 Commerce Ave Ne Prior Lake MN 55372-1495 Ph: (952) 440-3100 | 14093 Commerce Ave Ne Prior Lake MN 55372-1495 Ph: (952) 440-3100 |
| NPI Number | 1033545439 |
|---|---|
| Provider Enumeration Date | 09/18/2013 |
| Last Update Date | 09/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033545439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPCC (Minnesota) | Primary |
Resilient Fusion Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3662 Pointe Pass Nw, Prior Lake, MN 55372 Phone: 952-210-2724 | |
Thrive Therapy Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3733 Fox Tail Trl Nw, Prior Lake, MN 55372 Phone: 507-350-2120 | |
Kala Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4769 Dakota St Se, Suite 2, Prior Lake, MN 55372 Phone: 952-447-4344 | |
Redwood Counseling Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 4201 Quaker Trl Ne, Prior Lake, MN 55372 Phone: 320-282-6027 |