Organization
THE LAKE GROUP LLC
Active
Other names
Mound Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
BETTINA STUECHER (OWNER)
(651) 235-6493
Entity
Organization
Contact information
Practice address
4500 PARK GLEN ROAD #155, ST. LOUIS PARK, MN 55416
(612) 223-7992
(952) 928-9774
Mailing address
4500 PARK GLEN ROAD #155, ST. LOUIS PARK, MN 55416
(612) 223-7992
(952) 928-9774
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
133N00000X
Nutritionist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5H617PO
BLUE CROSS
MN
Enumeration date
07/27/2009
Last updated
11/11/2024
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