Provider Demographics
NPI:1447721634
Name:REINECKE LEBEDEVA, PATRICIA MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:REINECKE LEBEDEVA
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 1:3104 CHELSEA CT
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1000
Mailing Address - Country:US
Mailing Address - Phone:612-669-7377
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE 330
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1798
Practice Address - Country:US
Practice Address - Phone:612-435-7208
Practice Address - Fax:612-435-7201
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional