Provider Demographics
NPI:1043935257
Name:FRUTH, LYDIA HELEN (LPCC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:HELEN
Last Name:FRUTH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1969
Mailing Address - Country:US
Mailing Address - Phone:320-761-0326
Mailing Address - Fax:
Practice Address - Street 1:2380 TROOP DR UNIT 201
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4637
Practice Address - Country:US
Practice Address - Phone:763-633-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional