Active NPI
Lisa J. Matzke, LPC
- Professional Counselor
- North Mankato, MN
National Provider Identifier
1053697979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 01108
- Practice address
- 1445 Lookout Dr Ste 200
North Mankato, MN 56003-2501 - Phone
- (507) 340-5126
- Fax
- (507) 345-8861
- NPI assigned
- Oct 24, 2011
- Last updated
- Oct 24, 2011
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 01108 | MN | Primary |
Addresses
Primary practice location
1445 Lookout Dr Ste 200
North Mankato, MN 56003-2501
Mailing address
1445 Lookout Dr Ste 200
North Mankato, MN 56003-2501
Phone (507) 340-5126
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01108 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1053697979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1445 LOOKOUT DR STE 200",
"city": "NORTH MANKATO",
"state": "MN",
"postal_code": "560032501",
"telephone_number": "507-340-5126",
"fax_number": "507-345-8861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 LOOKOUT DR STE 200",
"city": "NORTH MANKATO",
"state": "MN",
"postal_code": "560032501",
"telephone_number": "507-340-5126",
"fax_number": "507-345-8861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATZKE",
"first_name": "LISA",
"middle_name": "J.",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-24",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "01108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.