Provider Demographics
NPI:1063866010
Name:NOS-TOLLEFSON, LISA ELIZABETH (PSYD LPCC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELIZABETH
Last Name:NOS-TOLLEFSON
Suffix:
Gender:F
Credentials:PSYD LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HOLSTEIN DR NE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1464
Mailing Address - Country:US
Mailing Address - Phone:320-322-5122
Mailing Address - Fax:844-990-4122
Practice Address - Street 1:1100 HOLSTEIN DR NE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1464
Practice Address - Country:US
Practice Address - Phone:320-322-5122
Practice Address - Fax:844-990-4122
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty