The Lake Group LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

THE LAKE GROUP LLC

Doing business as

Mound Psychological Services

Practice address

4500 Park Glen Road #155
St. Louis Park, MN 55416

Phone

(612) 223-7992

Fax

(952) 928-9774

NPI assigned

Jul 27, 2009

Last updated

Nov 11, 2024By 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

Bettina StuecherNPI 1790678241

Title

Owner

Phone

(651) 235-6493

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Mound Psychological Services Doing business as

Locations

Practitioners 5

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.

• Bettina Stuecher

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1790678241
  NPD Authorized official
• Dawn Diana Draayer-Thibodeau, LICSW

  • Clinical Social Worker
  • St Louis Park, MN
  • NPI 1972672087
  NPD (past)
• Audrey Mae Frederickson, PSY D

  • Clinical Psychologist
  • Mound, MN
  • NPI 1689681298
  NPD (past)
• Brian Edward Powers II, PHD

  • Clinical Psychologist
  • St Louis Park, MN
  • NPI 1558383794
  NPD (past)
• Jennifer Lynn Wigton, PH.D.

  • Psychologist
  • St Louis Park, MN
  • NPI 1336238419
  NPD (past)

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1346471232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN ROAD #155",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-223-7992",
            "fax_number": "952-928-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARK GLEN ROAD #155",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-223-7992",
            "fax_number": "952-928-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "STUECHER",
        "authorized_official_first_name": "BETTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-235-6493"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5H617PO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mound Psychological Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.