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General NPI Number Information
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NPI Number | 1043380074
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Entity Type | Individual
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Provider Name | KIRSTEN LYSNE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3001 HENNEPIN AVE SOUTH #B301
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City | MPLS
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State | MN
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Zip | 55408
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Country | US
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Telephone | 612-825-3440
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Fax | 612-827-2477
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Provider Business Mailing Address
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Address Line | 3001 HENNEPIN AVE SO #B301
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City | MPLS
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State | MN
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Zip | 55408
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Country | US
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Telephone | 612-825-3440
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Fax | 612-827-2477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3655
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License Number State | MN
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