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General NPI Number Information
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NPI Number | 1922547454
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Entity Type | Individual
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Provider Name | LISANDRY MICHELLE HALEY ORTIZ LPCC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 606 24TH AVE S STE 602
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1438
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Country | US
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Telephone | 952-997-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 6425 NICOLLET AVE
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City | RICHFIELD
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State | MN
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Zip | 55423-1675
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Country | US
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Telephone | 612-861-1675
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Fax | 612-861-3446
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 02311
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3032
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License Number State | MN
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