Provider Demographics
NPI:1831744929
Name:RICHMOND, ELLEN ANN (LPCC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 SOUTHTOWN CTR # 177
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1324
Mailing Address - Country:US
Mailing Address - Phone:507-338-2668
Mailing Address - Fax:612-416-2101
Practice Address - Street 1:8832 HUMBOLDT AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2053
Practice Address - Country:US
Practice Address - Phone:507-338-2668
Practice Address - Fax:612-416-2101
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03467101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health