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General NPI Number Information
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NPI Number | 1124740071
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Entity Type | Organization
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Legal Business Name | ODYSSEY COUNSELING LTD
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 5780 LINCOLN DR STE 123
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City | EDINA
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State | MN
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Zip | 55436-1600
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Country | US
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Telephone | 952-592-8114
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Fax | 952-209-6622
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Provider Business Mailing Address
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Address Line | 5780 LINCOLN DR STE 123
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City | EDINA
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State | MN
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Zip | 55436-1600
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Country | US
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Telephone | 952-592-8114
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Fax | 952-209-6622
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | REECE FORRESTER
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Credential | MA, LMFT
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Telephone | 952-592-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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