Provider Demographics
NPI:1437118551
Name:CASEY, LYSLE LEE (MA LP)
Entity Type:Individual
Prefix:
First Name:LYSLE
Middle Name:LEE
Last Name:CASEY
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N 2ND AVE E
Mailing Address - Street 2:STE 300
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-727-5400
Mailing Address - Fax:218-727-0077
Practice Address - Street 1:8 N 2ND AVE E
Practice Address - Street 2:STE 300
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-727-5400
Practice Address - Fax:218-727-0077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist