Healthcare Provider Details

I. General information

NPI: 1164752333
Provider Name (Legal Business Name): LORI R CAO LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 LAKE ST E SUITE 204
WAYZATA MN
55391-1980
US

IV. Provider business mailing address

3903 MORNINGSIDE RD
EDINA MN
55416-5024
US

V. Phone/Fax

Practice location:
  • Phone: 952-261-8468
  • Fax:
Mailing address:
  • Phone: 952-261-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2064
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: