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General NPI Number Information
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NPI Number | 1043133770
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Entity Type | Organization
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Legal Business Name | ELIJAH INSTITUTE
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 16224 HOMINY PATH
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City | LAKEVILLE
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State | MN
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Zip | 55044-3817
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Country | US
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Telephone | 952-260-8447
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Fax |
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Provider Business Mailing Address
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Address Line | 7635 148TH ST W # 193
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City | SAINT PAUL
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State | MN
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Zip | 55124-7800
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Country | US
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Telephone | 952-260-8447
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | REBECCA BRUBAKER
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Credential |
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Telephone | 612-240-3814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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