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NPI Code Detail

MEDICARE: DR LISA E-THERAPY

MEDICARE: DR LISA E-THERAPY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker
3106H00000XMarriage & Family Therapist
42084P0800XPsychiatry Physician
5364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
6103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1770120933
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR LISA E-THERAPY
Provider Business Mailing Address
First Line : 3539 DOUGLAS DR N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-2415
Country : US
Telephone Number : 612-642-1355
Fax Number : 612-756-7059
Provider Business Practice Location Address
First Line : 3539 DOUGLAS DR N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55422-2415
Country : US
Telephone Number : 612-642-1355
Fax Number : 612-756-7059
Authorized Official
Title or Position : OWNER, CLINICAL PSYCHOLOGY
Name : DR. LISA EILEEN LOVELACE
Credential : PSYD
Telephone Number : 612-642-1355
Provider Enumeration Date : 12/06/2019
Last Update Date : 11/03/2021

Similar Medicare Providers

1104090646 — DR. LISA EILEEN LOVELACE PSY.D.
Practice Location Address:
3539 DOUGLAS DR N
MINNEAPOLIS, MN
55422-2415
Practice Phone: 612-642-1355
Practice Fax: 612-756-7059
1710779822 — EMMA RAE HAASE
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55422-2415
Practice Phone: 612-642-1355
Practice Fax:
1376336784 — COURTNEY RENEE SETZER
Practice Location Address:
3539 DOUGLAS DR N
MINNEAPOLIS, MN
55422-2415
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Practice Fax:
1972493054 — JESSICA LEWIS BS
Practice Location Address:
3539 DOUGLAS DR N
MINNEAPOLIS, MN
55422-2415
Practice Phone: 612-642-1355
Practice Fax:
1497647655 — PERCY SMITH
Practice Location Address:
3539 DOUGLAS DR N
MINNEAPOLIS, MN
55422-2415
Practice Phone: 612-642-1355
Practice Fax:
1841253366 — NEW HOPE CRYSTAL MEDICAL CLINIC
Practice Location Address:
3501 DOUGLAS DR N
CRYSTAL, MN
55422-2415
Practice Phone: 763-535-9601
Practice Fax: 763-535-5601

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