Basic Information
| Provider Information | |||||||||
| NPI: | 1447750047 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKMAN | ||||||||
| FirstName: | LIISA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MPS, LPCC LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 MAIN STREET | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551123271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123267575 | ||||||||
| FaxNumber: | 6124542430 | ||||||||
| Practice Location | |||||||||
| Address1: | 1821 UNIVERSITY AVE W STE N385 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551042872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6124542484 | ||||||||
| FaxNumber: | 6516479147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2018 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 304846 | MN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 2331 | MN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 304846 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 304846 | 01 | MN | LICENSED ALCOHOL AND DRUG COUNSELOR (LADC) | OTHER |