Provider Demographics
NPI:1568642841
Name:FELSCH, ERIC LESTER (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LESTER
Last Name:FELSCH
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 33RD ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5197
Mailing Address - Country:US
Mailing Address - Phone:320-217-6012
Mailing Address - Fax:
Practice Address - Street 1:1407 33RD ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5197
Practice Address - Country:US
Practice Address - Phone:320-217-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical