Provider Demographics
NPI:1063435543
Name:LIANE, CATHY (MSLP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LIANE
Suffix:
Gender:F
Credentials:MSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-0068
Mailing Address - Country:US
Mailing Address - Phone:218-821-4923
Mailing Address - Fax:218-961-4923
Practice Address - Street 1:4820 COUNTY ROAD 77
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2708
Practice Address - Country:US
Practice Address - Phone:218-821-4923
Practice Address - Fax:218-961-4923
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP1535103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111780OtherUCARE
MN969050600Medicaid
MN103209OtherHEALTH PARTNERS
MN111780OtherBHP
MN6201430OtherUBH MEDICA
MN801312OtherARAZ
MN8H059LIOtherBCBS