Provider Demographics
NPI:1477685691
Name:WEST LAKE FAMILY SERVICES
Entity Type:Organization
Organization Name:WEST LAKE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:763-383-0247
Mailing Address - Street 1:18020 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1627
Mailing Address - Country:US
Mailing Address - Phone:763-383-0247
Mailing Address - Fax:763-577-9924
Practice Address - Street 1:700 TWELVE OAKS CENTER DR
Practice Address - Street 2:#260 UPSTAIRS
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4401
Practice Address - Country:US
Practice Address - Phone:763-383-0247
Practice Address - Fax:763-577-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1325251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health