# LAKESHORE FAMILY THERAPY LLC

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

## Provider details

- **NPI number:** 1699179994
- **Authorized official:** MRS. KELLY LEE ROSE LMFT (OWNER)
- **Authorized official phone:** (651) 231-7471

## Contact information

- **Practice address:** 3701 SHORELINE DR STE 102A, WAYZATA, MN 55391-4000
- **Practice address phone:** (651) 231-7471
- **Mailing address:** 3701 SHORELINE DR STE 102A, WAYZATA, MN 55391-4000
- **Mailing address phone:** (651) 231-7471

## Taxonomy

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

## Other

- **Enumeration date:** 10/15/2014
- **Last updated:** 05/19/2025