Healthcare Provider Details

I. General information

NPI: 1417386764
Provider Name (Legal Business Name): LISA PERLOCK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 SLATER RD STE 120
EAGAN MN
55122-4048
US

IV. Provider business mailing address

14300 NICOLLET CT SUITE 130
BURNSVILLE MN
55306-4501
US

V. Phone/Fax

Practice location:
  • Phone: 952-388-5893
  • Fax: 612-246-3682
Mailing address:
  • Phone: 952-435-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00660
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: