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General NPI Number Information
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NPI Number | 1922554294
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Entity Type | Individual
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Provider Name | ELLEN E O'BRIEN MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 9000 QUANTRELLE AVE NE STE 102
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City | OTSEGO
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State | MN
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Zip | 55330-1029
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Country | US
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Telephone | 612-217-0277
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Fax | 612-329-0017
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Provider Business Mailing Address
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Address Line | 15400 75TH CIR NE
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City | OTSEGO
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State | MN
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Zip | 55330-1036
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Country | US
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Telephone | 612-965-8488
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3376
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License Number State | MN
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