Healthcare Provider Details

I. General information

NPI: 1316158439
Provider Name (Legal Business Name): CHRISTIANNE M LYSNE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIANNE M GARSAULT PHD

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W CAVOUR AVE
FERGUS FALLS MN
56537-2103
US

IV. Provider business mailing address

225 W CAVOUR AVE
FERGUS FALLS MN
56537-2103
US

V. Phone/Fax

Practice location:
  • Phone: 218-998-3123
  • Fax: 218-998-3126
Mailing address:
  • Phone: 218-998-3123
  • Fax: 218-998-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4844
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: