| Lee Thao | |
|
2489 Rice St Ste 180 Roseville MN 55113-3795 | |
| (612) 314-3076 | |
| (651) 377-4363 |
| Full Name | Lee Thao |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2489 Rice St Ste 180, Roseville, Minnesota |
| Authorized Official Name and Position | Lee Thao (OWNER) |
| Authorized Official Contact | 6123143076 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee Thao 1377 County Road E W Arden Hills MN 55112-3654 Ph: (651) 503-9787 | Lee Thao 2489 Rice St Ste 180 Roseville MN 55113-3795 Ph: (612) 314-3076 |
| NPI Number | 1952180515 |
|---|---|
| Provider Enumeration Date | 09/25/2023 |
| Last Update Date | 10/24/2024 |
| Certification Date | 10/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952180515 | NPI | - | NPPES |
| 1972012391 | Medicaid | MN |
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