Provider Demographics
NPI:1922554294
Name:O'BRIEN, ELLEN E (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 75TH CIR NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1036
Mailing Address - Country:US
Mailing Address - Phone:612-965-8488
Mailing Address - Fax:
Practice Address - Street 1:9000 QUANTRELLE AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-1029
Practice Address - Country:US
Practice Address - Phone:612-217-0277
Practice Address - Fax:612-329-0017
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3376106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist