=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205694825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN O'BRIEN EDD,LPCC-S,NCC,RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2024
-----------------------------------------------------
Last Update Date | 03/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 N MAIN ST
-----------------------------------------------------
City | LE SUEUR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56058-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-858-3019
-----------------------------------------------------
Fax | 507-512-7091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36430 311TH AVE
-----------------------------------------------------
City | LE SUEUR
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56058-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-269-9896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | CC04296
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------