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NPI Code Detail

MEDICARE: LISA MEDIN

MEDICARE: LISA MEDIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMN

General Provider Information

NPI Number : 1790416709
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MEDIN
Provider Business Mailing Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 508-955-3790
Fax Number :
Provider Business Practice Location Address
First Line : 1403 SILVER LAKE RD NW STE 2
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-9308
Country : US
Telephone Number : 508-955-3790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2022
Last Update Date : 06/21/2022

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Directions to “ LISA MEDIN ” Practice Location

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