Provider Demographics
NPI:1740918622
Name:OLDRE, ELIZABETH ELIN (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELIN
Last Name:OLDRE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ELIN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7743 COUNTY ROAD 11 NE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8188
Mailing Address - Country:US
Mailing Address - Phone:612-247-3685
Mailing Address - Fax:
Practice Address - Street 1:7743 COUNTY ROAD 11 NE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-8188
Practice Address - Country:US
Practice Address - Phone:612-247-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional