Provider Demographics
NPI:1801090055
Name:KASTENBAUER, LISA C (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:KASTENBAUER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7362 UNIVERSITY AVE NE
Mailing Address - Street 2:302
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3142
Mailing Address - Country:US
Mailing Address - Phone:763-572-8187
Mailing Address - Fax:763-572-2060
Practice Address - Street 1:7362 UNIVERSITY AVE NE
Practice Address - Street 2:302
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3142
Practice Address - Country:US
Practice Address - Phone:763-572-8187
Practice Address - Fax:763-572-2060
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist