Provider Demographics
NPI:1124541644
Name:TRUMP, LISA JENNET (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JENNET
Last Name:TRUMP
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SE MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2151
Mailing Address - Country:US
Mailing Address - Phone:1612-886-2524
Mailing Address - Fax:
Practice Address - Street 1:219 SE MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2151
Practice Address - Country:US
Practice Address - Phone:1612-886-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3334103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily