Provider Demographics
NPI:1003581273
Name:ALEX EATON PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:ALEX EATON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:701-839-0474
Mailing Address - Street 1:1705 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2912
Mailing Address - Country:US
Mailing Address - Phone:701-839-0474
Mailing Address - Fax:
Practice Address - Street 1:1705 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2912
Practice Address - Country:US
Practice Address - Phone:701-839-0474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)