| Lisa Bonahoom Llc | |
|
1850 W Wayzata Blvd Ste 150 Long Lake MN 55356-4415 | |
| (952) 240-9404 | |
| Not Available |
| Full Name | Lisa Bonahoom Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1850 W Wayzata Blvd Ste 150, Long Lake, Minnesota |
| Authorized Official Name and Position | Lisa Bonahoom (MA, LMFT) |
| Authorized Official Contact | 9522409404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Bonahoom Llc 1830 Pheasant Dr Excelsior MN 55331-9061 Ph: (952) 240-9404 | Lisa Bonahoom Llc 1850 W Wayzata Blvd Ste 150 Long Lake MN 55356-4415 Ph: (952) 240-9404 |
| NPI Number | 1033921069 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/26/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033921069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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