NPIMap

Organization Active NPI

Dr Lisa E-Therapy

Doing business as Synergy eTherapy

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1770120933
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
DR LISA E-THERAPY
Doing business as
Synergy eTherapy
Practice address
3539 Douglas Dr N
Minneapolis, MN 55422-2415
Phone
(612) 642-1355
Fax
(612) 756-7059
NPI assigned
Dec 6, 2019
Last updated
Nov 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Authorized official

Name
Dr. Lisa Eileen Lovelace, PSYDNPI 1104090646
Title
Owner, Clinical Psychology
Phone
(612) 642-1355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0808X

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

Other names 1

  • Synergy eTherapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211112001623 MN Part B Supplier - Clinic/Group Practice 1951790955 Receives reassigned benefits from 1 practitioner
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Locations

3539 Douglas Dr N
Minneapolis, MN 55422
Phone (612) 429-4232

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635897600000",
    "number": "1770120933",
    "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": {
        "organization_name": "DR LISA E-THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-06",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "LOVELACE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "EILEEN",
        "authorized_official_title_or_position": "OWNER, CLINICAL PSYCHOLOGY",
        "authorized_official_telephone_number": "612-642-1355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy eTherapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Synergy eTherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.