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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