Provider Demographics
NPI:1275119752
Name:HAVELIN, LISA JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:HAVELIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JANE
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:572 LINCOLN AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2835
Mailing Address - Country:US
Mailing Address - Phone:651-230-4035
Mailing Address - Fax:
Practice Address - Street 1:572 LINCOLN AVE APT 11
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2835
Practice Address - Country:US
Practice Address - Phone:651-230-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist