Individual
MISS LISA MORTIE REYNOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
630 E MAIN ST, ANOKA, MN 55303-2527
(763) 712-1903
(763) 712-1917
Mailing address
12497 DRAKE ST NW, COON RAPIDS, MN 55448-2095
(763) 464-7219
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
573
MN
Other
Enumeration date
04/09/2013
Last updated
08/18/2014
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