Provider Demographics
NPI:1740434570
Name:FOO, LISA SIMONE (PHD,LP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SIMONE
Last Name:FOO
Suffix:
Gender:F
Credentials:PHD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3044
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE SOUTH
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-3044
Practice Address - Fax:612-630-8242
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist