Provider Demographics
NPI:1952680456
Name:WEIR, LISA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:WEIR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 10TH AVE S STE 212
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9481
Mailing Address - Country:US
Mailing Address - Phone:866-522-2472
Mailing Address - Fax:
Practice Address - Street 1:904 MAINSTREET STE 200
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7589
Practice Address - Country:US
Practice Address - Phone:952-562-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist