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General NPI Number Information
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NPI Number | 1760791248
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Entity Type | Individual
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Provider Name | ELIZABETH JORDAN-O'DONNELL M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 10650 COUNTY ROAD 81 SUITE 205
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4075
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Country | US
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Telephone | 763-424-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 10650 COUNTY ROAD 81 SUITE 205
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4075
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Country | US
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Telephone | 763-424-2100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 303640
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC00759
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License Number State | MN
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