| Behavioral Wellness | |
|
14093 Commerce Ave Ne Prior Lake MN 55372-1495 | |
| (952) 440-3100 | |
| (952) 440-3100 |
| Full Name | Behavioral Wellness |
|---|---|
| Speciality | Counselor - Professional |
| Location | 14093 Commerce Ave Ne, Prior Lake, Minnesota |
| Authorized Official Name and Position | Tracy Lee Kling Kotval (DIRECTOR) |
| Authorized Official Contact | 9524403100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Wellness 14093 Commerce Ave Ne Prior Lake MN 55372-1495 Ph: (952) 440-3100 | Behavioral Wellness 14093 Commerce Ave Ne Prior Lake MN 55372-1495 Ph: (952) 440-3100 |
| NPI Number | 1033545439 |
|---|---|
| Provider Enumeration Date | 09/18/2013 |
| Last Update Date | 09/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033545439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPCC (Minnesota) | Primary |
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