Arisa Koyama Lyseng

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC03768 Issued in MN

Practice address

4660 Slater Rd Ste 120
Eagan, MN 55122-4048

Phone

(612) 441-3255

NPI assigned

Sep 14, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1548810260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD STE 120",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224048",
            "telephone_number": "612-441-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD STE 120",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224048",
            "telephone_number": "612-441-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSENG",
        "first_name": "ARISA",
        "middle_name": "KOYAMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-14",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC03768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Dale Lutz
• Luxottica of America Inc (Oakley B193)
• Lyle J. Swenson, M.D, P.a
• Sean Quentin Lynch, PT
• Dylan Lyons, MA, LPCC
• M & H Caring Hands LLC
• Hibaq Maadey
• Hafsio Bdirahman Maalim
• Andrew D Maas, MD
• Rayan Ali Macalin

• Mental Health Counselor in Eagan, MN
• Providers in Eagan, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.