Active NPI
Lakes Wellness Center LLC
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1841664190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5667
- Legal business name
- LAKES WELLNESS CENTER LLC
- Practice address
- 3248 Stevens Ave
Minneapolis, MN 55408-3214 - Phone
- (813) 401-7624
- NPI assigned
- Nov 24, 2015
- Last updated
- Nov 24, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Anisa Sophia Mohammed, PSYD
- Title
- Licensed Psychologist
- Phone
- (813) 401-7624
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP5667 | MN | Primary |
Addresses
Primary practice location
3248 Stevens Ave
Minneapolis, MN 55408-3214
Mailing address
3248 Stevens Ave
Minneapolis, MN 55408-3214
Phone (813) 401-7624
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448323200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1448323200000",
"number": "1841664190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3248 STEVENS AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554083214",
"telephone_number": "813-401-7624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3248 STEVENS AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554083214",
"telephone_number": "813-401-7624"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKES WELLNESS CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-24",
"last_updated": "2015-11-24",
"status": "A",
"authorized_official_last_name": "MOHAMMED",
"authorized_official_first_name": "ANISA",
"authorized_official_middle_name": "SOPHIA",
"authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
"authorized_official_telephone_number": "813-401-7624",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSYD"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5667",
"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 Nov 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.