Lisa Marie Rutford, MA, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01825 Issued in MN

Practice address

6550 York Ave S Ste 503
Edina, MN 55435-2336

Phone

(952) 426-3034

NPI assigned

Jun 18, 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

Other names 1

• Miss Lisa Marie Caponigri Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Mary Mullenbach PHD LP IncGroup PAC ID 5799950283, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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

• Mary Mullenbach, PHD, LP, Inc

  • Psychologist
  • Edina, MN
  • NPI 1801182837
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1821658253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3531 10TH AVE S UNIT 2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072115",
            "telephone_number": "847-293-9649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 YORK AVE S STE 503",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352336",
            "telephone_number": "952-426-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTFORD",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MA, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "CAPONIGRI",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Russell N. Frys Jr,, DDS PA
• Laura Christine Russell, RD, CDE
• Margaret Patricia Russell, BS
• David G Rustad, MD
• Jill Harriet Rusterholz, M.D.
• RX Angels LLC
• Barb Ryan, L.M.T.
• Glen Ryan, MD
• Waleed Saadedeen, MD
• Benjamin Saaribovre, DC

• Professional Counselor in Edina, MN
• Providers in Edina, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.