Provider Demographics
NPI:1902446537
Name:STEARNS BROWN, LISA L
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:STEARNS BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W 65TH ST UNIT 23145
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1483
Mailing Address - Country:US
Mailing Address - Phone:612-900-6368
Mailing Address - Fax:
Practice Address - Street 1:7012 HARRIET AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3060
Practice Address - Country:US
Practice Address - Phone:612-849-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304387101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)