Organization
LISA BONAHOOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BONAHOOM (MA, LMFT)
(952) 240-9404
Entity
Organization
Contact information
Practice address
1850 W WAYZATA BLVD STE 150, LONG LAKE, MN 55356-4415
(952) 240-9404
Mailing address
1830 PHEASANT DR, EXCELSIOR, MN 55331-9061
(952) 240-9404
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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