Provider Information for 1366737520
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LISA L STEVENSON MS LPCC
Other Names:Former Name:LISA L OLSONSex: Female
NPI: 1366737520
Last Updated: 2018-04-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366737520 | ||||||||||||
| Enumeration Date | 2011-06-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 14551 JUDICIAL RD STE 100 BURNSVILLE, MN 55306-4991 United States Phone: 952-898-5020 | Fax: | ||||||||||||
| Primary Practice Address | 14551 JUDICIAL RD STE 100 BURNSVILLE, MN 55306-4991 United States Phone: 952-898-5020 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1600 UNIVERSITY AVE W | ||||||||||||
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