Individual
MRS. JISON ELLEN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
2550 BLAISDELL AVE S, MINNEAPOLIS, MN 55404
(612) 532-9100
(612) 813-5399
Mailing address
2550 BLAISDELL AVE S, MINNEAPOLIS, MN 55404
(612) 532-9100
(612) 813-5399
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC00683
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P1-089-7373-0
BCBS PIN
MI
Enumeration date
01/16/2007
Last updated
05/28/2009
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