Provider Demographics
NPI:1740490549
Name:MOREY, ELDON LEROY (PHD MINNESOTA LICENS)
Entity type:Individual
Prefix:
First Name:ELDON
Middle Name:LEROY
Last Name:MOREY
Suffix:
Gender:M
Credentials:PHD MINNESOTA LICENS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:MOTLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56466-0156
Mailing Address - Country:US
Mailing Address - Phone:218-352-6543
Mailing Address - Fax:218-352-6543
Practice Address - Street 1:2224 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:MOTLEY
Practice Address - State:MN
Practice Address - Zip Code:56466-0156
Practice Address - Country:US
Practice Address - Phone:218-352-6543
Practice Address - Fax:218-352-6543
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical