Provider Demographics
NPI:1871851253
Name:RAINES, LISA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:RAINES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CHATFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1134
Mailing Address - Country:US
Mailing Address - Phone:612-483-4464
Mailing Address - Fax:
Practice Address - Street 1:8170 OLD CARRIAGE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3163
Practice Address - Country:US
Practice Address - Phone:612-483-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist