Organization
LAKES WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANISA SOPHIA MOHAMMED PSYD (LICENSED PSYCHOLOGIST)
(813) 401-7624
Entity
Organization
Contact information
Practice address
3248 STEVENS AVE, MINNEAPOLIS, MN 55408-3214
(813) 401-7624
Mailing address
3248 STEVENS AVE, MINNEAPOLIS, MN 55408-3214
(813) 401-7624
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5667
MN
Other
Enumeration date
11/24/2015
Last updated
11/24/2015
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