NPIMap

Organization Active NPI

Stacia Hanson Ma LP LLC

Doing business as Lilium Center

  • Psychologist
  • Edina, MN
National Provider Identifier
1871867549
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
STACIA HANSON MA LP LLC
Doing business as
Lilium Center
Practice address
7101 York Ave S Suite 317
Edina, MN 55435
Phone
(952) 921-3266
Fax
(651) 224-3765
NPI assigned
Feb 28, 2012
Last updated
Sep 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Stacia Hanson, MA LPNPI 1033347505
Title
Ceo, Owner
Phone
(952) 921-3266

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary
Clinical Psychologist 103TC0700X NU

Addresses

Primary practice location

7101 York Ave S Suite 317
Edina, MN 55435

Mailing address

7101 York Ave S Suite 317
Edina, MN 55435
Phone (952) 921-3266

Other names 1

  • Lilium Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240312003412 MN Part B Supplier - Clinic/Group Practice 2769828706 Receives reassigned benefits from 16 practitioners
Practice locations: Edina, MN; Saint Paul, MN

National Provider Directory

National Provider Directory

Locations

7101 York Ave S
Ste 317
Minneapolis, MN 55435
Phone (763) 703-4207

1197 Grand Ave
Saint Paul, MN 55105
Phone (763) 703-4215

889 Grand Ave
Ste 203
Saint Paul, MN 55105

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1871867549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 YORK AVE S SUITE 317",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-921-3266",
            "fax_number": "651-224-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 YORK AVE S SUITE 317",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-921-3266",
            "fax_number": "651-224-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACIA HANSON MA LP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "STACIA",
        "authorized_official_title_or_position": "CEO, OWNER",
        "authorized_official_telephone_number": "952-921-3266",
        "authorized_official_credential": "MA LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lilium Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.