Lisa Mortie Reynoso, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

573 Issued in MN

Practice address

630 E Main St
Anoka, MN 55303-2527

Phone

(763) 712-1903

Fax

(763) 712-1917

NPI assigned

Apr 9, 2013

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

• Lisa Mortie Ray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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 and National Provider Directory roles.

• Genuine Therapy Center

  • Community/Behavioral Health Agency
  • Anoka, MN
  • NPI 1841493608
  NPD (past)
• Optiovillage, Inc

  • Community/Behavioral Health Agency
  • Anoka, MN
  • NPI 1184002784
  NPD (past)

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408320000000",
    "number": "1861835829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12497 DRAKE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482095",
            "telephone_number": "763-464-7219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E MAIN ST",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032527",
            "telephone_number": "763-712-1903",
            "fax_number": "763-712-1917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "LISA",
        "middle_name": "MORTIE",
        "name_prefix": "Miss",
        "credential": "MA, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-09",
        "last_updated": "2014-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "RAY",
            "middle_name": "MORTIE",
            "credential": "MA, LPCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brittney Reinecke
• John Reitan
• Rensch, Becker and Iwen, D.D.S., P.a.
• Scott E. Rensch, D.D.S.
• Austin Rewerts
• Haley Rezac
• Rhonda Johnson, MSW, Licsw LLC
• Hannah Rider
• Fiona Rife
• Catherine Elaine Rincon, LPN

• Mental Health Counselor in Anoka, MN
• Providers in Anoka, 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 Aug 18, 2014; 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.