Provider Demographics
NPI:1760791248
Name:JORDAN-O'DONNELL, ELIZABETH (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:JORDAN-O'DONNELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:10650 COUNTY ROAD 81
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4075
Mailing Address - Country:US
Mailing Address - Phone:763-424-2100
Mailing Address - Fax:
Practice Address - Street 1:10650 COUNTY ROAD 81
Practice Address - Street 2:SUITE 205
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4075
Practice Address - Country:US
Practice Address - Phone:763-424-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303640101YA0400X
MNCC00759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)