Provider Demographics
NPI:1639645898
Name:EVENSON, LYNANNE (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:LYNANNE
Middle Name:
Last Name:EVENSON
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 2ND ST STE 180
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-5000
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:1300 S 2ND ST STE 180
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-5000
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist