# LISA BONAHOOM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033921069
- **Authorized official:** LISA BONAHOOM (MA, LMFT)
- **Authorized official phone:** (952) 240-9404

## Contact information

- **Practice address:** 1850 W WAYZATA BLVD STE 150, LONG LAKE, MN 55356-4415
- **Practice address phone:** (952) 240-9404
- **Mailing address:** 1830 PHEASANT DR, EXCELSIOR, MN 55331-9061
- **Mailing address phone:** (952) 240-9404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2025
- **Last updated:** 01/27/2025