Healthcare Provider Details

I. General information

NPI: 1851864789
Provider Name (Legal Business Name): LISA MARIE KUECHENMEISTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALNUT ST
DAWSON MN
56232-2333
US

IV. Provider business mailing address

1282 WALNUT ST
DAWSON MN
56232-2333
US

V. Phone/Fax

Practice location:
  • Phone: 320-769-4323
  • Fax:
Mailing address:
  • Phone: 320-769-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC02020
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: