Provider Demographics
NPI:1841764339
Name:OMALLEY, MAGGIE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3492
Mailing Address - Country:US
Mailing Address - Phone:612-474-0255
Mailing Address - Fax:
Practice Address - Street 1:658 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3492
Practice Address - Country:US
Practice Address - Phone:612-474-0255
Practice Address - Fax:612-223-8899
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health