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Organization
LAKE MINNETONKA COUNSELING
Active
Organization
LAKE MINNETONKA COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MARIE BAUMAN LICSW,, LADC, BCC (THERAPIST)
(612) 386-2311
Entity
Organization
Contact information
Practice address
432 MILL ST, SUITE 201, LONG LAKE, MN 55356-8304
(612) 386-2311
Mailing address
470 COUNTY ROAD 110 NORTH, MINNETRISTA, MN 55364-8315
(612) 386-2311
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
18016
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
18016
MN
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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