Provider Demographics
NPI:1306045653
Name:BEYER, ELAINE LOUISE (LP)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:LOUISE
Last Name:BEYER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3330
Mailing Address - Country:US
Mailing Address - Phone:612-827-8013
Mailing Address - Fax:
Practice Address - Street 1:3338 HUMBOLDT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3330
Practice Address - Country:US
Practice Address - Phone:612-827-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3828103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling