Active NPI
Lisa Eileen Lovelace, PSY.D.
- Psychologist
- Minneapolis, MN
National Provider Identifier
1104090646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP5379
- Practice address
- 3539 Douglas Dr N
Minneapolis, MN 55422-2415 - Phone
- (612) 642-1355
- Fax
- (612) 756-7059
- NPI assigned
- Apr 16, 2008
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3561-57 | WI | |
| Clinical Psychologist | 103TC0700X | 017260 | NY | |
| Psychologist | 103T00000X | LP5379 | MN | Primary |
Addresses
Primary practice location
3539 Douglas Dr N
Minneapolis, MN 55422-2415
Mailing address
3539 Douglas Dr N
Minneapolis, MN 55422-2415
Phone (612) 642-1355
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lherman178244@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 16, 2025 through May 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3561-57 | WI | MD | Clinical Psychologist |
| 017260 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1104090646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3539 DOUGLAS DR N",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554222415",
"telephone_number": "612-642-1355",
"fax_number": "612-756-7059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3539 DOUGLAS DR N",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554222415",
"telephone_number": "612-642-1355",
"fax_number": "612-756-7059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOVELACE",
"first_name": "LISA",
"middle_name": "EILEEN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-16",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "3561-57",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "017260",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP5379",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lherman178244@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "4300 Edgewood Dr NE",
"city": "Saint Michael",
"state": "MN",
"country_code": "US",
"postal_code": "553764588",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.