Provider Demographics
NPI:1891816260
Name:ERVIN, LISA JEAN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JEAN
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9952 NORD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2339
Mailing Address - Country:US
Mailing Address - Phone:952-956-0076
Mailing Address - Fax:952-835-5679
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 338
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-345-4510
Practice Address - Fax:952-835-5679
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180P7EROtherBCBSMN GROUP PROVIDER #
MN98G51EROtherBBSMN IND. PROVIDER #