Active NPI
Kirsten Lysne, PH.D.
- Clinical Psychologist
- MPLS, MN
National Provider Identifier
1043380074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP3655
- Practice address
- 3001 Hennepin Ave South
#B301
MPLS, MN 55408 - Phone
- (612) 825-3440
- Fax
- (612) 827-2477
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP3655 | MN | Primary |
Addresses
Primary practice location
3001 Hennepin Ave South
#B301
MPLS, MN 55408
Mailing address
3001 Hennepin Ave So
#B301
MPLS, MN 55408
Phone (612) 825-3440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61-77329 | Other | MN | UNITED BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moxie Incorporated | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043380074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 HENNEPIN AVE SO",
"address_2": "#B301",
"city": "MPLS",
"state": "MN",
"postal_code": "55408",
"telephone_number": "612-825-3440",
"fax_number": "612-827-2477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 HENNEPIN AVE SOUTH",
"address_2": "#B301",
"city": "MPLS",
"state": "MN",
"postal_code": "55408",
"telephone_number": "612-825-3440",
"fax_number": "612-827-2477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSNE",
"first_name": "KIRSTEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP3655",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "61-77329",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in MPLS, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.