Lake Victoria Mental Health Services, PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LAKE VICTORIA MENTAL HEALTH SERVICES, PC

Practice address

3405 Chicago Ave
Minneapolis, MN 55407-2107

Phone

(651) 724-0497

NPI assigned

May 4, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Zachary Olson, MSW

Title

Owner, Director, Psychotherapist

Phone

(651) 724-0497

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1023377488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "978 DAYTON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072107",
            "telephone_number": "651-724-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE VICTORIA MENTAL HEALTH SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_title_or_position": "OWNER, DIRECTOR, PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "651-724-0497",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.