NPIMap

Organization Active NPI

Lyn-Lake Psychotherapy and Wellness LTD.

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1609355163
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
LYN-LAKE PSYCHOTHERAPY AND WELLNESS LTD.
Practice address
621 W Lake St Ste 350
Minneapolis, MN 55408-2952
Phone
(612) 979-2276
Fax
(651) 925-0427
NPI assigned
Aug 7, 2018
Last updated
Jan 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Authorized official

Name
Dr. Emily Rose Van Wyk, PSY.D., LPNPI 1174939961
Title
President
Phone
(651) 485-8417

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

621 W Lake St Ste 350
Minneapolis, MN 55408-2952

Mailing address

621 W Lake St Ste 350
Minneapolis, MN 55408-2952
Phone (612) 979-2276

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201224000071 MN Part B Supplier - Clinic/Group Practice 9638581291 Receives reassigned benefits from 147 practitioners
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Locations

1516 W Lake St
Ste 220
Minneapolis, MN 55408
Phone (651) 336-6048

2900 Thomas Ave S
Ste 100
Minneapolis, MN 55416

3033 Excelsior Blvd
Ste 215
Minneapolis, MN 55416
Phone (612) 268-4777

3033 Excelsior Blvd
Ste 465
Minneapolis, MN 55416
Phone (612) 226-8901

3112 Hennepin Ave
Minneapolis, MN 55408
Phone (612) 395-4967

333 Washington Ave N
Ste 500
Minneapolis, MN 55401
Phone (612) 345-8193

Practitioners & affiliated clinicians

Practitioners 157

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.

View all 157

NPI Registry JSON

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

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1609355163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 W LAKE ST STE 350",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082952",
            "telephone_number": "612-979-2276",
            "fax_number": "651-925-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W LAKE ST STE 350",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082952",
            "telephone_number": "612-979-2276",
            "fax_number": "651-925-0427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYN-LAKE PSYCHOTHERAPY AND WELLNESS LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-07",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "VAN WYK",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-485-8417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.