Provider Demographics
NPI:1417675612
Name:ELEANOR PORTER-NELSON, INC
Entity Type:Organization
Organization Name:ELEANOR PORTER-NELSON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:847-702-1764
Mailing Address - Street 1:2136 FORD PKWY # 5294
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2850
Mailing Address - Country:US
Mailing Address - Phone:612-467-9924
Mailing Address - Fax:612-234-4261
Practice Address - Street 1:2136 FORD PKWY # 5294
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2850
Practice Address - Country:US
Practice Address - Phone:612-467-9924
Practice Address - Fax:612-234-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty