Doctor Name: | MS. LISA J. MATZKE |
NPI Number: | 1053697979 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 01108 |
Business Practice Address: | 1445 Lookout Dr Ste 200 North Mankato, MN - 560032501 |
Business Phone Number: | 5073405126 |
Business Fax Number: | 5073458861 |
Mailing Address: | 1445 Lookout Dr Ste 200, NORTH MANKATO |
State: | MN |
Postal Code: | 560032501 |
Phone Number: | 5073405126 |
Fax Number: | 5073458861 |
NPI Enumeration Date: | 10/24/2011 |
NPI Last Update Date: | 10/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 01108 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |