Provider Demographics
NPI:1548424096
Name:ENGELEN, ELISHA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:ANN
Last Name:ENGELEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E 5TH ST
Mailing Address - Street 2:#202
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2251
Mailing Address - Country:US
Mailing Address - Phone:952-448-7052
Mailing Address - Fax:952-448-7029
Practice Address - Street 1:112 E 5TH ST
Practice Address - Street 2:#202
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2251
Practice Address - Country:US
Practice Address - Phone:952-448-7052
Practice Address - Fax:952-448-7029
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist