Organization
WAVES OF CHANGE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYN TAYLOR LPC (LICENSED PROFESSIONAL COUNSELOR)
(612) 567-0278
Entity
Organization
Contact information
Practice address
20730 HOLYOKE AVE, SUITE 137, LAKEVILLE, MN 55044-9826
(612) 567-0278
Mailing address
PO BOX 366, LAKEVILLE, MN 55044-0366
(612) 567-0278
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
01373
MN
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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