Organization
LIFE DEVELOPMENT RESOURCES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM TRACY ROSS (PROGRAM MANAGER)
(952) 564-6337
Entity
Organization
Contact information
Practice address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(952) 898-1133
(952) 435-6797
Mailing address
7580 160TH ST W, LAKEVILLE, MN 55044-8348
(952) 898-1133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
MN
261Q00000X
Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
01/03/2007
Last updated
01/18/2025
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