| Life Development Resources, Pa | |
|
7580 160th St W Lakeville MN 55044-8348 | |
| (952) 898-1133 | |
| (952) 435-6797 |
| Full Name | Life Development Resources, Pa |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7580 160th St W, Lakeville, Minnesota |
| Authorized Official Name and Position | Kim Tracy Ross (PROGRAM MANAGER) |
| Authorized Official Contact | 9525646337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Development Resources, Pa 7580 160th St W Lakeville MN 55044-8348 Ph: (952) 898-1133 | Life Development Resources, Pa 7580 160th St W Lakeville MN 55044-8348 Ph: (952) 898-1133 |
| NPI Number | 1902953169 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 01/18/2018 |
| Medicare PECOS PAC ID | 5890779847 |
|---|---|
| Medicare Enrollment ID | O20040616000985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902953169 | NPI | - | NPPES |
| Provider Name | Jill Marie Ell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669610671 PECOS PAC ID: 2860559267 Enrollment ID: I20090331000087 |
| Provider Name | Roselyn B Busscher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689768756 PECOS PAC ID: 7315921392 Enrollment ID: I20101116000748 |
| Provider Name | Hector R Matascastillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093051526 PECOS PAC ID: 0749427888 Enrollment ID: I20130509000596 |
| Provider Name | Kimberly A Shepherd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346871944 PECOS PAC ID: 2860820529 Enrollment ID: I20200312001152 |
| Provider Name | Haylee Marie Baier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992458731 PECOS PAC ID: 3476940677 Enrollment ID: I20220418001127 |
| Provider Name | Casandra Ann Webber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821267030 PECOS PAC ID: 0648654830 Enrollment ID: I20220907003616 |
| Provider Name | Linda M Tunell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003959347 PECOS PAC ID: 9133592363 Enrollment ID: I20230308002258 |
| Provider Name | Kristin Oscarson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689451338 PECOS PAC ID: 5193170314 Enrollment ID: I20231009000954 |
| Provider Name | Katherine Ann Patras Legut |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760540272 PECOS PAC ID: 5991155665 Enrollment ID: I20231220002984 |
| Provider Name | Dianne M Henschel |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528779014 PECOS PAC ID: 6204286552 Enrollment ID: I20231228001858 |
| Provider Name | Michelle Ann Obermueller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477290302 PECOS PAC ID: 1153772140 Enrollment ID: I20240103003363 |
| Provider Name | Michele Jacqueline White |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275886632 PECOS PAC ID: 0042663734 Enrollment ID: I20240130000690 |
| Provider Name | Shane Moe |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1558774620 PECOS PAC ID: 6901249069 Enrollment ID: I20240206003650 |
| Provider Name | Alan Olson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083703987 PECOS PAC ID: 5294178653 Enrollment ID: I20240213002268 |
| Provider Name | Morgann Gould |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104503812 PECOS PAC ID: 1658715347 Enrollment ID: I20240221002601 |
| Provider Name | Madeline Christine Bullock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427827310 PECOS PAC ID: 8123463577 Enrollment ID: I20240226002204 |
| Provider Name | Christopher Ronald Thole |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619251022 PECOS PAC ID: 4183069313 Enrollment ID: I20240228000672 |
| Provider Name | Nicholas Weidner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033627716 PECOS PAC ID: 6800232893 Enrollment ID: I20240313000900 |
| Provider Name | Rachel Marie Schmidt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841909405 PECOS PAC ID: 0547609364 Enrollment ID: I20240412002365 |
| Provider Name | Erin Bird |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1053067058 PECOS PAC ID: 9335588086 Enrollment ID: I20240415002772 |
| Provider Name | David Jerome Hemingway |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336272434 PECOS PAC ID: 7810337920 Enrollment ID: I20240506001731 |
| Provider Name | Lucas John Moulder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386150142 PECOS PAC ID: 5991146284 Enrollment ID: I20240517001508 |
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