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Organization
WEST LAKE COUNSELING AND WELLNESS, INC
Active
Organization
WEST LAKE COUNSELING AND WELLNESS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA BAUMAN MIZUHATA LICSW (PRESIDENT)
(612) 386-2311
Entity
Organization
Contact information
Practice address
1613 W WAYZATA BLVD STE B, LONG LAKE, MN 55356-4103
(612) 386-2311
Mailing address
470 COUNTY ROAD 110 N, MOUND, MN 55364-8315
(612) 386-2311
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18016
MN
1041C0700X
Clinical Social Worker
18044
MN
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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