Organization
TONKA LIFE CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN V NELSON LP, LSP (OWNER)
(952) 393-6280
Entity
Organization
Contact information
Practice address
1605 W WAYZATA BLVD, LONG LAKE, MN 55356-9300
(888) 209-0305
(952) 442-3620
Mailing address
400 10TH ST E, WACONIA, MN 55387-4552
(888) 209-0305
(952) 442-3620
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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