Provider Demographics
NPI:1912364126
Name:ATKINSON, LISA MARIE (LMFT, ATR-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 CENTRE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-638-1564
Mailing Address - Fax:651-638-1580
Practice Address - Street 1:2990 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1182
Practice Address - Country:US
Practice Address - Phone:651-638-1564
Practice Address - Fax:651-638-1580
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3419106H00000X
MN17-478221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist