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General NPI Number Information
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NPI Number | 1821658253
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Entity Type | Individual
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Provider Name | LISA MARIE RUTFORD MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 6550 YORK AVE S STE 503
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City | EDINA
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State | MN
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Zip | 55435-2336
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Country | US
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Telephone | 952-426-3034
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Fax |
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Provider Business Mailing Address
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Address Line | 3531 10TH AVE S UNIT 2
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-2115
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Country | US
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Telephone | 847-293-9649
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC01825
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License Number State | MN
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