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General NPI Number Information
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NPI Number | 1417675612
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Entity Type | Organization
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Legal Business Name | ELEANOR PORTER-NELSON, INC
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 2136 FORD PKWY # 5294
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 612-467-9924
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Fax | 612-234-4261
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Provider Business Mailing Address
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Address Line | 2136 FORD PKWY # 5294
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 612-467-9924
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Fax | 612-234-4261
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Authorized Official
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Title or Position | OWNER
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Name | ELEANOR PORTER-NELSON
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Credential | LICSW
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Telephone | 847-702-1764
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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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