| Lakeville Family Therapy | |
|
17595 Kenwood Trl Suite 210 Lakeville MN 55044-9226 | |
| (612) 750-0263 | |
| Not Available |
| Full Name | Lakeville Family Therapy |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 17595 Kenwood Trl, Lakeville, Minnesota |
| Authorized Official Name and Position | Kathleen Marie Kelly (OWNER) |
| Authorized Official Contact | 6127500263 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeville Family Therapy 17595 Kenwood Trl Suite 210 Lakeville MN 55044-9226 Ph: (612) 750-0263 | Lakeville Family Therapy 17595 Kenwood Trl Suite 210 Lakeville MN 55044-9226 Ph: (612) 750-0263 |
| NPI Number | 1114268943 |
|---|---|
| Provider Enumeration Date | 03/04/2013 |
| Last Update Date | 03/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114268943 | NPI | - | NPPES |
| 1972800753 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 19327 (Minnesota) | Primary |
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