Provider Demographics
NPI:1356630040
Name:TERRI O'DONNELL LPC SASA LLC
Entity Type:Organization
Organization Name:TERRI O'DONNELL LPC SASA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SASA
Authorized Official - Phone:608-347-5015
Mailing Address - Street 1:2828 NASHUA LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9551
Mailing Address - Country:US
Mailing Address - Phone:608-347-5015
Mailing Address - Fax:
Practice Address - Street 1:802 W BROADWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1821
Practice Address - Country:US
Practice Address - Phone:608-347-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2011-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4013-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty