Organization
LAKE REGION THERAPEUTIC SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIRAZAQ IBRAHIM (OWNER)
(602) 323-4873
Entity
Organization
Contact information
Practice address
1007 MAINSTREET, HOPKINS, MN 55343-7517
(952) 456-6352
(952) 303-3104
Mailing address
3055 OLD HIGHWAY 8 STE 347, SAINT ANTHONY, MN 55418-2500
(952) 657-0884
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2019
Last updated
09/13/2023
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