Individual
LISA MARIE SMITH INMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LPCC
Contact information
Practice address
712 VISTA BLVD SUITE #172, WACONIA, MN 55387
(612) 440-6882
Mailing address
712 VISTA BLVD SUITE #172, WACONIA, MN 55387
(612) 440-6882
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CC01162
MN
101YM0800X
Mental Health Counselor
CC01162
MN
101YP2500X
Professional Counselor
Primary
CC01162
MN
Other
Enumeration date
08/29/2012
Last updated
04/19/2021
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