Provider Demographics
NPI:1114774361
Name:ENGELSTAD, LISA ANN (LPC (MN))
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ENGELSTAD
Suffix:
Gender:F
Credentials:LPC (MN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7256 JANERO AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-2289
Mailing Address - Country:US
Mailing Address - Phone:651-260-2074
Mailing Address - Fax:
Practice Address - Street 1:6936 PINE ARBOR DR S STE 200
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4672
Practice Address - Country:US
Practice Address - Phone:651-461-2903
Practice Address - Fax:651-461-2904
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional