Healthcare Provider Details

I. General information

NPI: 1770765455
Provider Name (Legal Business Name): ELANCORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 6TH ST SUITE 5
RAPID CITY SD
57701
US

IV. Provider business mailing address

8550 COUNTRYSIDE BLVD.
RAPID CITY SD
57702
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-1062
  • Fax:
Mailing address:
  • Phone: 605-343-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC761
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC761
License Number StateSD

VIII. Authorized Official

Name: DR. LYNN G MEINERS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 605-343-1062