Provider Demographics
NPI:1053033068
Name:LR PSYCHIATRY & COUNSELING SERVICES
Entity type:Organization
Organization Name:LR PSYCHIATRY & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:763-913-1042
Mailing Address - Street 1:1525 196TH LN NW
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55011-4437
Mailing Address - Country:US
Mailing Address - Phone:763-913-1042
Mailing Address - Fax:
Practice Address - Street 1:1525 196TH LN NW
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MN
Practice Address - Zip Code:55011-4437
Practice Address - Country:US
Practice Address - Phone:763-913-1042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty