Provider Demographics
NPI:1932854981
Name:ELEANOR HEALTH PROFESSIONAL TX, PLLC
Entity Type:Organization
Organization Name:ELEANOR HEALTH PROFESSIONAL TX, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SADE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-366-8743
Mailing Address - Street 1:221 CRESCENT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3425
Mailing Address - Country:US
Mailing Address - Phone:919-366-8743
Mailing Address - Fax:
Practice Address - Street 1:8500 VILLAGE DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5510
Practice Address - Country:US
Practice Address - Phone:726-201-3047
Practice Address - Fax:833-629-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty