DR. LISA EILEEN LOVELACE PSY.D.
NPI 1104090646
Psychologist in Minneapolis, MN

Active since April 16, 2008Opted out of Medicare · through May 16, 2027
3539 DOUGLAS DR N, MINNEAPOLIS, MN 55422(612) 642-1355(612) 756-7059 Get Directions Write a Review

NPPES record last updated: January 14, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 14, 2021, Nov 10, 2020, Jul 22, 2019 (3 updates tracked since 2019).

About Dr. Lisa Eileen Lovelace Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LISA EILEEN LOVELACE PSY.D. (NPI 1104090646) is an individual psychologist in Minneapolis, Minnesota, licensed in Minnesota (LP5379) and active in the NPI registry since April 2008. She has opted out of Medicare through May 16, 2027.

NPPES Registry Identity

NPI1104090646
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. LISA EILEEN LOVELACECredential: PSY.D.
Location Address3539 DOUGLAS DR NMinneapolis, MN 55422-2415
Mailing Address3539 Douglas Dr NMinneapolis, MN 55422-2415 · (612) 642-1355 · Fax (612) 756-7059
Fax(612) 756-7059
Sole ProprietorYes
Enumeration DateApril 16, 2008
Last NPPES UpdateJanuary 14, 20213 updates tracked since enumeration
NPPES CertifiedJanuary 14, 2021
NPI 1104090646 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in MN · LP5379
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 017260 (NY), 3561-57 (WI)
3539 DOUGLAS DR N, Minneapolis, MN 55422

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Lisa Eileen Lovelace Psy.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 16, 2025 through May 16, 2027.

Opt-Out Effective DateMay 16, 2025
Opt-Out In Effect ThroughMay 16, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Student in an Organized Health Care Education/Training Program
3539 DOUGLAS DR N
MINNEAPOLIS, MN 55422
Psychologist (Clinical)
3539 DOUGLAS DR N
MINNEAPOLIS, MN 55422
Marriage & Family Therapist
3539 DOUGLAS DR N
MINNEAPOLIS, MN 55422

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lisa Lovelace's NPI number?

The NPI number for Lisa Lovelace is 1104090646. It was assigned to this individual provider in the NPPES registry on April 16, 2008.

Where is Lisa Lovelace located?

Lisa Lovelace practices at 3539 Douglas Dr N, Minneapolis, MN 55422. The listed phone number is (612) 642-1355.

What is Lisa Lovelace's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Lisa Lovelace enrolled in Medicare?

No. Lisa Lovelace has opted out of Medicare through May 16, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Lisa Lovelace was last updated on January 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.