Provider Demographics
NPI:1669585253
Name:TORBORG, LISA J (PSY D)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:TORBORG
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Gender:F
Credentials:PSY D
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Other - Credentials:
Mailing Address - Street 1:1740 W SAINT GERMAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4059
Mailing Address - Country:US
Mailing Address - Phone:320-251-0223
Mailing Address - Fax:320-251-0172
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 301
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1314
Practice Address - Country:US
Practice Address - Phone:320-252-2976
Practice Address - Fax:320-656-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP4710103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN797206700Medicaid
MN680002195Medicare PIN