Healthcare Provider Details

I. General information

NPI: 1164331401
Provider Name (Legal Business Name): MAI ZIA LISA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 RUTH ST S
SAINT PAUL MN
55119-6659
US

IV. Provider business mailing address

1553 HUDSON RD
SAINT PAUL MN
55106-6129
US

V. Phone/Fax

Practice location:
  • Phone: 651-744-3601
  • Fax: 651-744-6681
Mailing address:
  • Phone: 651-744-3601
  • Fax: 651-744-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23210
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: