Provider Demographics
NPI:1114086188
Name:DECATHELINEAU, LISA JOY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JOY
Last Name:DECATHELINEAU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 230TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1828
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:320-231-9140
Practice Address - Street 1:1234 MN-7
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265
Practice Address - Country:US
Practice Address - Phone:320-269-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN801929100Medicaid
1033823OtherPREFERRED ONE
172691OtherUCARE
374J68TOtherBLUE CROSS