Provider Demographics
NPI:1265483515
Name:MUNTZ, ELENI (PHD)
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:MUNTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 WEST 41ST STREET #110
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:701-361-4982
Mailing Address - Fax:605-271-6672
Practice Address - Street 1:2522 W 41ST ST # 110
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6120
Practice Address - Country:US
Practice Address - Phone:701-361-4982
Practice Address - Fax:605-271-6672
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND151103G00000X
SD481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical