Healthcare Provider Details

I. General information

NPI: 1891629275
Provider Name (Legal Business Name): THREE LAKES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AMERICAN BLVD W STE 8052
BLOOMINGTON MN
55431-4420
US

IV. Provider business mailing address

2300 W 96TH ST
BLOOMINGTON MN
55431-2408
US

V. Phone/Fax

Practice location:
  • Phone: 612-272-0703
  • Fax:
Mailing address:
  • Phone: 612-812-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RAHAMIM (RAMI) LAHYANI
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 612-272-0703