Provider Demographics
NPI:1285100263
Name:BORGMANN, LYNN RENEE (MA, LADC, LPC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RENEE
Last Name:BORGMANN
Suffix:
Gender:F
Credentials:MA, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD N STE L70
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7167
Mailing Address - Country:US
Mailing Address - Phone:763-898-3838
Mailing Address - Fax:
Practice Address - Street 1:12000 ELM CREEK BLVD N STE L70
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7167
Practice Address - Country:US
Practice Address - Phone:763-898-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health