Healthcare Provider Details

I. General information

NPI: 1134513666
Provider Name (Legal Business Name): LOUISA LIENKE MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 VALLEY CREEK RD STE 220
WOODBURY MN
55125-2258
US

IV. Provider business mailing address

6949 VALLEY CREEK RD STE 220
WOODBURY MN
55125-2258
US

V. Phone/Fax

Practice location:
  • Phone: 651-442-9109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3033
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: