Provider Demographics
NPI:1902300783
Name:FOSNESS, ELENA (LMFT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:FOSNESS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARSCHALL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2690
Mailing Address - Country:US
Mailing Address - Phone:952-856-3932
Mailing Address - Fax:952-945-9536
Practice Address - Street 1:500 MARSCHALL RD STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2689
Practice Address - Country:US
Practice Address - Phone:952-448-6557
Practice Address - Fax:952-448-6047
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist