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General NPI Number Information
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NPI Number | 1700359874
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Entity Type | Organization
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Legal Business Name | LAKES COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 121 HENNEPIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55401-1802
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Country | US
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Telephone | 612-412-3318
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Fax | 612-288-1805
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Provider Business Mailing Address
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Address Line | 121 HENNEPIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55401-1802
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Country | US
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Telephone | 612-412-3318
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Fax | 612-288-1805
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Authorized Official
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Title or Position | PRESIDENT
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Name | INTISAR OMAR HUSSEIN
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Credential | MSW LICSW
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Telephone | 612-412-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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