Provider Demographics
NPI:1831305408
Name:LAURSEN, ADRIENNE C (MA, LAMFT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:C
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4330
Mailing Address - Country:US
Mailing Address - Phone:612-250-4577
Mailing Address - Fax:
Practice Address - Street 1:17113 MINNETONKA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-1100
Practice Address - Country:US
Practice Address - Phone:612-250-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist