Provider Demographics
NPI:1528364494
Name:SIMONSEN, ELLEN POTTER (LPCC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:POTTER
Last Name:SIMONSEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 WAYZATA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1349
Mailing Address - Country:US
Mailing Address - Phone:763-566-0088
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1349
Practice Address - Country:US
Practice Address - Phone:763-566-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional