Provider Demographics
NPI:1750541082
Name:LYMAN, ELAINE J (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:J
Last Name:LYMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 210TH ST W
Mailing Address - Street 2:SUITE 140 I
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5707
Mailing Address - Country:US
Mailing Address - Phone:952-486-3380
Mailing Address - Fax:
Practice Address - Street 1:8500 210TH ST W
Practice Address - Street 2:SUITE 140 I
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5707
Practice Address - Country:US
Practice Address - Phone:952-486-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health