Provider Demographics
NPI:1447750047
Name:BECKMAN, LIISA ANN (MPS, LPCC LADC)
Entity Type:Individual
Prefix:MS
First Name:LIISA
Middle Name:ANN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:MPS, LPCC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-326-7575
Mailing Address - Fax:612-454-2430
Practice Address - Street 1:1821 UNIVERSITY AVE W STE N385
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2872
Practice Address - Country:US
Practice Address - Phone:612-454-2484
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304846101YA0400X, 101YP2500X
MN2331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN304846OtherLICENSED ALCOHOL AND DRUG COUNSELOR (LADC)