Provider Demographics
NPI:1538419551
Name:VANDERVEEN-NAGEL, LISA R (MS, LPCC, LICSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:VANDERVEEN-NAGEL
Suffix:
Gender:F
Credentials:MS, LPCC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2756
Mailing Address - Country:US
Mailing Address - Phone:507-301-3412
Mailing Address - Fax:507-301-3308
Practice Address - Street 1:2208 JEAN WAY
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MN
Practice Address - Zip Code:55054-5421
Practice Address - Country:US
Practice Address - Phone:952-461-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional