Lake Minnetonka Counseling

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

18016 Issued in MN

Legal business name

LAKE MINNETONKA COUNSELING

Practice address

432 Mill St
Suite 201
Long Lake, MN 55356-8304

Phone

(612) 386-2311

NPI assigned

Feb 8, 2012

Last updated

Feb 8, 2012By 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

Tara Marie Bauman, LICSW,, LADC, BCC

Title

Therapist

Phone

(612) 386-2311

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1578835310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 COUNTY ROAD 110 NORTH",
            "city": "MINNETRISTA",
            "state": "MN",
            "postal_code": "553648315",
            "telephone_number": "612-386-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 MILL ST",
            "address_2": "SUITE 201",
            "city": "LONG LAKE",
            "state": "MN",
            "postal_code": "553568304",
            "telephone_number": "612-386-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MINNETONKA COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-08",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "BAUMAN",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "612-386-2311",
        "authorized_official_credential": "LICSW,, LADC, BCC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "18016",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "18016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas J McNaught D D S P a (Long Lake Dental)
• Stephanie Drake, D.D.S.
• Alissa Huhn, PHARMD
• Jonathan Kodet, PHD,LP
• Nichole Hirsch Kuechle, HOLISTIC PRACTITIONE
• Lakeside Counseling
• Brianne Levandoski
• Lisa Bonahoom LLC
• Long Lake Assisted Living
• Long Lake Eye LLC

• Adolescent and Children Mental Health Clinic/Center in Long Lake, MN
• Providers in Long Lake, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; 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.