Individual
BETHANY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
220 RAILROAD ST SE, PINE CITY, MN 55063-1540
(320) 629-7600
(320) 629-7900
Mailing address
220 RAILROAD ST SE, PINE CITY, MN 55063-1540
(320) 629-7600
(320) 629-7900
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2468
MN
Other
Enumeration date
01/23/2012
Last updated
04/24/2018
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