| West Lake Counseling And Wellness, Inc | |
|
1613 W Wayzata Blvd Ste B Long Lake MN 55356-4103 | |
| (612) 386-2311 | |
| Not Available |
| Full Name | West Lake Counseling And Wellness, Inc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1613 W Wayzata Blvd Ste B, Long Lake, Minnesota |
| Authorized Official Name and Position | Tara Bauman Mizuhata (PRESIDENT) |
| Authorized Official Contact | 6123862311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Lake Counseling And Wellness, Inc 470 County Road 110 N Mound MN 55364-8315 Ph: (612) 386-2311 | West Lake Counseling And Wellness, Inc 1613 W Wayzata Blvd Ste B Long Lake MN 55356-4103 Ph: (612) 386-2311 |
| NPI Number | 1255791745 |
|---|---|
| Provider Enumeration Date | 02/26/2016 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255791745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 18016 (Minnesota) | Primary |
| 1041C0700X | Social Worker - Clinical | 18044 (Minnesota) | Secondary |
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