Lifespan of Minnesota, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

7076053 00 Issued in MN

Legal business name

LIFESPAN OF MINNESOTA, INC.

Practice address

12425 River Ridge Blvd
#200
Burnsville, MN 55337-4871

Phone

(952) 562-8500

Fax

(952) 562-8501

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Traci Lee Hackmann, MA LP

Title

Ceo/Clinical Director

Phone

(952) 562-8500

Specialties & licenses 2

Addresses

Other identifiers 5

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Lee Moen, MA, LPCC

  • Mental Health Counselor
  • Maple Grove, MN
  • NPI 1457790990
  NPD
• Emily Labukas, LMFT

  • Marriage & Family Therapist
  • Burnsville, MN
  • NPI 1205208949
  NPD (past)
• Stephanie Ann Palazzola, LICSW

  • Clinical Social Worker
  • Bloomington, MN
  • NPI 1922237148
  NPD (past)
• Jill Elizabeth Smith, LICSW

  • Clinical Social Worker
  • Burnsville, MN
  • NPI 1306013826
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710097274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12425 RIVER RIDGE BLVD",
            "address_2": "#200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374871",
            "telephone_number": "952-562-8500",
            "fax_number": "952-562-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12425 RIVER RIDGE BLVD",
            "address_2": "#200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374871",
            "telephone_number": "952-562-8500",
            "fax_number": "952-562-8501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13000 63rd Ave N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553696081",
            "country_code": "US",
            "telephone_number": "763-553-4003",
            "fax_number": "763-553-7743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFESPAN OF MINNESOTA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HACKMANN",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "952-562-8500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA LP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "7076053 00",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "7876190 00",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "454T4DA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "102020",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "100598",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "707605300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "787619000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Counseling LLC
• Life Interrupted Counseling Services
• Life Renewal Counseling LLC
• Life Time Transportation LLC
• Lifeborne Health LLC
• Lifetime Health Care Services Inc
• Lifetree Clinic
• Lily Wellness
• Liminal Journeys Therapy LLC
• Limitless, PLLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.