| Lakeshore Family Therapy, Llc | |
|
3701 Shoreline Dr Ste 102a Wayzata MN 55391-4000 | |
| (651) 231-7471 | |
| Not Available |
| Full Name | Lakeshore Family Therapy, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3701 Shoreline Dr Ste 102a, Wayzata, Minnesota |
| Authorized Official Name and Position | Kelly Lee Rose (OWNER) |
| Authorized Official Contact | 6512317471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Family Therapy, Llc 3701 Shoreline Dr Ste 102a Wayzata MN 55391-4000 Ph: (651) 231-7471 | Lakeshore Family Therapy, Llc 3701 Shoreline Dr Ste 102a Wayzata MN 55391-4000 Ph: (651) 231-7471 |
| NPI Number | 1699179994 |
|---|---|
| Provider Enumeration Date | 10/15/2014 |
| Last Update Date | 06/19/2024 |
| Certification Date | 06/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699179994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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