Provider Demographics
NPI:1417306937
Name:GRUNG, ELIANA KATHERINE (LPCC)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:KATHERINE
Last Name:GRUNG
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9737
Mailing Address - Country:US
Mailing Address - Phone:651-300-3791
Mailing Address - Fax:
Practice Address - Street 1:7041 20TH AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038-9737
Practice Address - Country:US
Practice Address - Phone:651-300-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional