Organization
LAKE VICTORIA MENTAL HEALTH SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY OLSON MSW (OWNER, DIRECTOR, PSYCHOTHERAPIST)
(651) 724-0497
Entity
Organization
Contact information
Practice address
3405 CHICAGO AVE, MINNEAPOLIS, MN 55407-2107
(651) 724-0497
Mailing address
978 DAYTON AVE, SAINT PAUL, MN 55104-6544
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/04/2012
Last updated
04/08/2013
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