| Tonka Life Center, Ltd | |
|
1605 W Wayzata Blvd Long Lake MN 55356-9300 | |
| (888) 209-0305 | |
| (952) 442-3620 |
| Full Name | Tonka Life Center, Ltd |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1605 W Wayzata Blvd, Long Lake, Minnesota |
| Authorized Official Name and Position | Brian V Nelson (OWNER) |
| Authorized Official Contact | 9523936280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tonka Life Center, Ltd 400 10th St E Waconia MN 55387-4552 Ph: (888) 209-0305 | Tonka Life Center, Ltd 1605 W Wayzata Blvd Long Lake MN 55356-9300 Ph: (888) 209-0305 |
| NPI Number | 1154988350 |
|---|---|
| Provider Enumeration Date | 05/22/2019 |
| Last Update Date | 05/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154988350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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