MEDICARE: SAKURA THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598488850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAKURA THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	280 QUEENAN AVE S
Second Line	:
City	:	LAKELAND
State	:	MN
Zip	:	55043-9463
Country	:	US
Telephone Number	:	651-233-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 HUDSON BLVD N STE 111
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-7098
Country	:	US
Telephone Number	:	651-448-2420
Fax Number	:	651-448-2425

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY E TOKUDA
Credential	:
Telephone Number	:	651-233-8966

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	03/16/2025

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