Provider Demographics
NPI:1770975690
Name:O'MALLEY, COURTNEY (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W SAINT GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3536
Mailing Address - Country:US
Mailing Address - Phone:320-259-5381
Mailing Address - Fax:320-259-6171
Practice Address - Street 1:821 W SAINT GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3536
Practice Address - Country:US
Practice Address - Phone:320-259-5381
Practice Address - Fax:320-259-6171
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health