Lakes Autism Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LAKES AUTISM CENTER

Practice address

1069 Grandview Way # 2-317
Columbia Heights, MN 55421-3376

Phone

(952) 221-6892

NPI assigned

Sep 29, 2021

Organization subpart

No

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

Authorized official

Name

Safia Farah Ali

Title

General Manager

Phone

(763) 329-4697

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1356013312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 GRANDVIEW WAY # 2-317",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554213376",
            "telephone_number": "952-221-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 GRANDVIEW WAY # 2-317",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554213376",
            "telephone_number": "952-221-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES AUTISM CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "SAFIA",
        "authorized_official_middle_name": "FARAH",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "763-329-4697"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faryal Khan, LMFT
• Sotricia King
• Nipa Shailesh Kulenkamp, DMD
• Josseline Ladjo
• Andrew Lake, LPN
• Mark W Lampman, DC
• Jason Thomas Lee, L.AC
• Lee's Nemt L.L.C
• Legacy Community Care Inc
• Legacy Security Technology, Inc.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Columbia Heights, MN
• Providers in Columbia Heights, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.