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Organization
MIDWEST MINDS ASSESSMENT AND THERAPY, PLLC
Active
Organization
MIDWEST MINDS ASSESSMENT AND THERAPY, PLLC
Active
Other names
Midwest Minds
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA NIPPOOLDT-BACA PSYD, LP, ABPP (NEUROPSYCHOLOGIST/OWNER)
(651) 283-0639
Entity
Organization
Contact information
Practice address
1937 WOODLANE DR STE 101, WOODBURY, MN 55125-4043
(651) 764-8480
Mailing address
1937 WOODLANE DR STE 101, WOODBURY, MN 55125-4043
(651) 764-8480
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356698294
—
MN
05
—
1467712182
—
MN
05
—
1568606077
—
MN
Enumeration date
06/04/2024
Last updated
10/07/2024
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