Provider Demographics
NPI:1265757124
Name:OVALDSON, ELAINE MARIE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:OVALDSON
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 1:8441 WAYZATA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1344
Mailing Address - Country:US
Mailing Address - Phone:763-566-0088
Mailing Address - Fax:763-566-0089
Practice Address - Street 1:8441 WAYZATA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1344
Practice Address - Country:US
Practice Address - Phone:763-566-0088
Practice Address - Fax:763-566-0089
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional