Provider Demographics
NPI:1578262333
Name:LAKE AND VALLEY FAMILY THERAPY
Entity Type:Organization
Organization Name:LAKE AND VALLEY FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-360-1995
Mailing Address - Street 1:2179 4TH ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3041
Mailing Address - Country:US
Mailing Address - Phone:651-360-1995
Mailing Address - Fax:651-666-1379
Practice Address - Street 1:2179 4TH ST STE 2F
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3041
Practice Address - Country:US
Practice Address - Phone:651-360-1995
Practice Address - Fax:651-666-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty