Provider Demographics
NPI:1689980955
Name:DUBOIS-SCHMITZ, LISA ANN (PSYD, LP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:DUBOIS-SCHMITZ
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HENNEPIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2619
Mailing Address - Country:US
Mailing Address - Phone:612-819-2036
Mailing Address - Fax:
Practice Address - Street 1:3108 HENNEPIN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2619
Practice Address - Country:US
Practice Address - Phone:612-819-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5151103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist