| Lakeside Psychological Services | |
|
2618 Emerald Dr Grand Rapids MN 55744-5060 | |
| (218) 327-9013 | |
| (218) 327-9013 |
| Full Name | Lakeside Psychological Services |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 2618 Emerald Dr, Grand Rapids, Minnesota |
| Authorized Official Name and Position | Coreen Ellen Lauseng (BILLING AGENT) |
| Authorized Official Contact | 9529351961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Psychological Services 2618 Emerald Dr Grand Rapids MN 55744-5060 Ph: (218) 327-9013 | Lakeside Psychological Services 2618 Emerald Dr Grand Rapids MN 55744-5060 Ph: (218) 327-9013 |
| NPI Number | 1316043458 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316043458 | NPI | - | NPPES |
| 8G811GR | Other | MN | BLUE CROSS BLUE SHIELD MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (Minnesota) | Primary |
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