Provider Demographics
NPI:1104813716
Name:TROUP, ELLIOTT V JR (MED LP)
Entity type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:V
Last Name:TROUP
Suffix:JR
Gender:M
Credentials:MED LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:431 S 7TH ST
Mailing Address - Street 2:#2402
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1821
Mailing Address - Country:US
Mailing Address - Phone:612-708-4242
Mailing Address - Fax:952-831-0530
Practice Address - Street 1:431 S 7TH ST
Practice Address - Street 2:#2402
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1821
Practice Address - Country:US
Practice Address - Phone:612-708-4242
Practice Address - Fax:952-831-0530
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist