Healthcare Provider Details

I. General information

NPI: 1952680456
Provider Name (Legal Business Name): LISA WEIR M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 WHITEWATER DR STE 310
MINNETONKA MN
55343-9347
US

IV. Provider business mailing address

2765 CASCO POINT RD
WAYZATA MN
55391-9798
US

V. Phone/Fax

Practice location:
  • Phone: 866-522-2472
  • Fax: 763-717-8049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2083
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: