Provider Demographics
NPI:1124740071
Name:ODYSSEY COUNSELING LTD
Entity type:Organization
Organization Name:ODYSSEY COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REECE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:952-592-8114
Mailing Address - Street 1:5780 LINCOLN DR STE 123
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1600
Mailing Address - Country:US
Mailing Address - Phone:952-592-8114
Mailing Address - Fax:952-209-6622
Practice Address - Street 1:5780 LINCOLN DR STE 123
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1600
Practice Address - Country:US
Practice Address - Phone:952-592-8114
Practice Address - Fax:952-209-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)