| Lakes Country Counseling Pllc | |
|
7251 Excelsior Rd Baxter MN 56425 | |
| (218) 454-0878 | |
| (218) 454-0879 |
| Full Name | Lakes Country Counseling Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7251 Excelsior Rd, Baxter, Minnesota |
| Authorized Official Name and Position | Stephen Vagle (OWNER) |
| Authorized Official Contact | 2184540878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakes Country Counseling Pllc 7251 Excelsior Rd Baxter MN 56425-8477 Ph: (218) 454-0878 | Lakes Country Counseling Pllc 7251 Excelsior Rd Baxter MN 56425 Ph: (218) 454-0878 |
| NPI Number | 1023322351 |
|---|---|
| Provider Enumeration Date | 07/28/2010 |
| Last Update Date | 07/03/2023 |
| Certification Date | 06/20/2023 |
| Medicare PECOS PAC ID | 7214257849 |
|---|---|
| Medicare Enrollment ID | O20161025000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023322351 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1531 (Minnesota) | Primary |
| Provider Name | Kimberly J Scearcy Senn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821230772 PECOS PAC ID: 1951575018 Enrollment ID: I20111130000008 |
| Provider Name | Julie A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083631576 PECOS PAC ID: 5698163079 Enrollment ID: I20211104001318 |
| Provider Name | Lily S. L. Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366172066 PECOS PAC ID: 3274915558 Enrollment ID: I20220803000883 |
| Provider Name | Tracey M Malone |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1326405788 PECOS PAC ID: 4082065818 Enrollment ID: I20240105002794 |
| Provider Name | Samantha F.r. Cole |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1609355171 PECOS PAC ID: 5890173306 Enrollment ID: I20240109000644 |
| Provider Name | Stephen E Vagle |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366616146 PECOS PAC ID: 8123306198 Enrollment ID: I20240110003836 |
| Provider Name | Luke T Hamilton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1912454257 PECOS PAC ID: 3476972753 Enrollment ID: I20240117000195 |
| Provider Name | Donette R Lair |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1508247149 PECOS PAC ID: 8224471297 Enrollment ID: I20240206004228 |
| Provider Name | Kelsey M Middleton |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144866302 PECOS PAC ID: 1355785551 Enrollment ID: I20240215002189 |
| Provider Name | Timothy Anderson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316303928 PECOS PAC ID: 4880030279 Enrollment ID: I20240307002272 |
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