Lakes Opioid Treatment Program, Inc

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

LAKES OPIOID TREATMENT PROGRAM, INC

Practice address

8381 Lake Land TRL NW
Walker, MN 56484-2109

Phone

(763) 412-9441

NPI assigned

Sep 20, 2016

Last updated

Oct 10, 2016By 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

Stephanie Dawn Losh

Title

Co-Owner

Phone

(612) 877-2465

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1104374073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15477 SODIUM ST NW",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "553035415",
            "telephone_number": "763-412-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8381 LAKE LAND TRL NW",
            "city": "WALKER",
            "state": "MN",
            "postal_code": "564842109",
            "telephone_number": "763-412-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES OPIOID TREATMENT PROGRAM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-20",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "LOSH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "612-877-2465"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Johnson (First Step Walker)
• Jeanette Ann Jochum-Lindstrom, MS, LPCC, NCC
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• Gus Vernon Kaubisch Jr., D.C.
• Thomas Grant Krumme, M.D.
• Annika Marit Lien, M.S., CCC-SLP
• Catherine Joyce Lowe, PA-C
• Tamera Lyn Mahaffey, NP
• May Creek Lodge Inc.
• Kathryn A Mell, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Walker, MN
• Providers in Walker, MN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.