Healthcare Provider Details

I. General information

NPI: 1659296739
Provider Name (Legal Business Name): LISA LEE FOX LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

IV. Provider business mailing address

618 JEFFERSON AVE
SAINT PETER MN
56082-1695
US

V. Phone/Fax

Practice location:
  • Phone: 507-985-3004
  • Fax:
Mailing address:
  • Phone: 334-201-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26256
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007001
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: