Lakeview Wellness LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

LAKEVIEW WELLNESS LLC

Practice address

408 3Rd St Ste 107
Farmington, MN 55024-1355

Phone

(176) 376-0213

Fax

(651) 390-6136

NPI assigned

Apr 4, 2023

Last updated

Sep 2, 2025By 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

Tessa Fultz, LICSWNPI 1568968204

Title

Owner/Therapist

Phone

(763) 760-2134

Specialties & licenses 3

Addresses

Other names 1

• Tessa Fultz Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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.

• Tessa Fultz, LICSW

  • Social Worker
  • Farmington, MN
  • NPI 1568968204
  Medicare reassignment NPD Authorized official
• Susan Laursen, MSW, LICSW

  • Clinical Social Worker
  • Edina, MN
  • NPI 1265200141
  NPD

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1780389189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 3RD ST STE 107",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550241355",
            "telephone_number": "507-649-2507",
            "fax_number": "651-390-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 3RD ST STE 107",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550241355",
            "telephone_number": "176-376-0213",
            "fax_number": "651-390-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-04",
        "last_updated": "2025-09-02",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "FULTZ",
        "authorized_official_first_name": "TESSA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "763-760-2134",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tessa Fultz",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kirk Hanson
• Abbey Elizabeth Knisely-Rengel, MA, CCC-SLP
• Ku4Love Home Health LLC
• Luanne Kuelbs
• Longchi Ndongla Kufor
• Britney Lallier, L.AC.
• Maryalice S Langevin, MA. CCC-SLP
• Josephine Sowie Lansana
• Bobbie Larson, OTR
• Jamie Joy Larson, 245D PROVIDER

• Social Worker in Farmington, MN
• Providers in Farmington, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.