Healthcare Provider Details

I. General information

NPI: 1851211189
Provider Name (Legal Business Name): LIBERTAE YOUR MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 BUCHANAN ST NE
MINNEAPOLIS MN
55418-1449
US

IV. Provider business mailing address

3335 BUCHANAN ST NE
MINNEAPOLIS MN
55418-1449
US

V. Phone/Fax

Practice location:
  • Phone: 651-263-4149
  • Fax:
Mailing address:
  • Phone: 651-263-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA D MENDOZA
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LPCC
Phone: 651-263-4149