Healthcare Provider Details

I. General information

NPI: 1790833200
Provider Name (Legal Business Name): DONALD RAY ELVERD PSY.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

IV. Provider business mailing address

15245 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

V. Phone/Fax

Practice location:
  • Phone: 651-213-4184
  • Fax: 651-213-4411
Mailing address:
  • Phone: 651-213-4184
  • Fax: 651-213-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3607
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: