Provider Demographics
NPI:1669299426
Name:WHITE OAK PSYCHOTHERAPY, LTD
Entity type:Organization
Organization Name:WHITE OAK PSYCHOTHERAPY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIS ZELADA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC, LPCC
Authorized Official - Phone:651-764-7023
Mailing Address - Street 1:611 BIELENBERG DR STE 109
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1431
Mailing Address - Country:US
Mailing Address - Phone:651-764-7023
Mailing Address - Fax:612-666-1612
Practice Address - Street 1:611 BIELENBERG DR STE 109
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1431
Practice Address - Country:US
Practice Address - Phone:651-764-7023
Practice Address - Fax:612-666-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health