Lisa Bonahoom LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

LISA BONAHOOM LLC

Practice address

1850 W Wayzata Blvd Ste 150
Long Lake, MN 55356-4415

Phone

(952) 240-9404

NPI assigned

Jan 27, 2025

Last updated

Jan 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa BonahoomNPI 1134507593

Title

Ma, LMFT

Phone

(952) 240-9404

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Bonahoom, LMFT

  • Marriage & Family Therapist
  • St Louis Park, MN
  • NPI 1134507593
  NPD Authorized official

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1033921069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 PHEASANT DR",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553319061",
            "telephone_number": "952-240-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W WAYZATA BLVD STE 150",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553564415",
            "telephone_number": "952-240-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA BONAHOOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-26",
        "status": "A",
        "authorized_official_last_name": "BONAHOOM",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "MA, LMFT",
        "authorized_official_telephone_number": "952-240-9404"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Kodet, PHD,LP
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• Long Lake Assisted Living
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• Joshua David Mazurek, DC
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• Kathryn Aschliman Muller, MA

• Marriage & Family Therapist in Long Lake, MN
• Providers in Long Lake, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.