| Life Roads, Llc | |
|
1068 Lake St S Suite 109 Forest Lake MN 55025-2639 | |
| (651) 230-0492 | |
| (651) 982-6035 |
| Full Name | Life Roads, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1068 Lake St S, Forest Lake, Minnesota |
| Authorized Official Name and Position | Sharon Rose Fries (OWNER) |
| Authorized Official Contact | 6512300492 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Roads, Llc 1068 Lake St S Suite 109 Forest Lake MN 55025-2639 Ph: (651) 230-0492 | Life Roads, Llc 1068 Lake St S Suite 109 Forest Lake MN 55025-2639 Ph: (651) 230-0492 |
| NPI Number | 1609091008 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 10/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609091008 | NPI | - | NPPES |
| 1601130-00 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 0938 (Minnesota) | Primary |
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