Provider Demographics
NPI:1023191731
Name:O'MALLEY-LAURSEN, ALAN J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:O'MALLEY-LAURSEN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4704
Practice Address - Country:US
Practice Address - Phone:507-451-2630
Practice Address - Fax:507-455-8133
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN011021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-20362OtherUNITED BEHAVIORAL HEALTH
MN68543OMOtherBLUE CROSS BLUE SHIELD
MN118033OtherUCARE
MNHP20275OtherHEALTH PARTNERS