| Tonka Life Center | |
|
3305 Casco Cir Wayzata MN 55391-9718 | |
| (952) 393-6280 | |
| (952) 471-7211 |
| Full Name | Tonka Life Center |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 3305 Casco Cir, Wayzata, Minnesota |
| Authorized Official Name and Position | Brian Vernon Nelson (OWNER) |
| Authorized Official Contact | 9523936280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tonka Life Center 3305 Casco Cir Wayzata MN 55391-9718 Ph: (952) 393-6280 | Tonka Life Center 3305 Casco Cir Wayzata MN 55391-9718 Ph: (952) 393-6280 |
| NPI Number | 1992171110 |
|---|---|
| Provider Enumeration Date | 08/12/2015 |
| Last Update Date | 10/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992171110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP1543 (Minnesota) | Primary |
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