Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Medicine Lake Consultation Group, PLLC

Organization Clinical Psychologist · NPI 1881753564

Medicine Lake Consultation Group, PLLC is a Clinical Psychologist in St Louis Park, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
Specialties on file
2
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1155 Ford Rd Unit B
St Louis Park, MN 55426
Phone: (952) 378-1800
Fax: (952) 378-1714
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 2084P0800X
Clinical Psychologist Taxonomy 103TC0700X · Licence 103TC0700X (MN)

Record details

NPI number1881753564
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ani Ram — Office Manager · (952) 378-1800
Other names Lakes Consultation Group
NPI enumeratedDecember 8, 2006
Last updated in NPPESJanuary 23, 2015
Mailing address1155 Ford Road, Unit B, St Louis Park, MN 55426

Other providers in St Louis Park