| Lakeside Psychology Services, Llc | |
|
4601 Excelsior Blvd Ste 340 St Louis Park MN 55416-5228 | |
| (612) 217-2719 | |
| Not Available |
| Full Name | Lakeside Psychology Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4601 Excelsior Blvd Ste 340, St Louis Park, Minnesota |
| Authorized Official Name and Position | Julie Anne Mckay (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 6122172719 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Psychology Services, Llc 4601 Excelsior Blvd Ste 340 St Louis Park MN 55416-5228 Ph: (612) 217-2719 | Lakeside Psychology Services, Llc 4601 Excelsior Blvd Ste 340 St Louis Park MN 55416-5228 Ph: (612) 217-2719 |
| NPI Number | 1174171649 |
|---|---|
| Provider Enumeration Date | 08/28/2019 |
| Last Update Date | 10/04/2022 |
| Certification Date | 02/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174171649 | NPI | - | NPPES |
| 1629410139 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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