| Lakes Psychological Practice, Llc | |
|
100 Fuller St S Shakopee MN 55379-1348 | |
| (612) 568-1475 | |
| Not Available |
| Full Name | Lakes Psychological Practice, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 100 Fuller St S, Shakopee, Minnesota |
| Authorized Official Name and Position | Anisa Sophia Mohammed (PSYCHOLOGIST) |
| Authorized Official Contact | 6125681475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakes Psychological Practice, Llc 3248 Stevens Ave Minneapolis MN 55408-3214 Ph: (813) 401-7624 | Lakes Psychological Practice, Llc 100 Fuller St S Shakopee MN 55379-1348 Ph: (612) 568-1475 |
| NPI Number | 1194232264 |
|---|---|
| Provider Enumeration Date | 01/10/2018 |
| Last Update Date | 01/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194232264 | NPI | - | NPPES |
| 1215364625 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP5667 (Minnesota) | Primary |
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