Provider Demographics
NPI:1508174624
Name:ELUVATHINGAL, JOSE LONAPPAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LONAPPAN
Last Name:ELUVATHINGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 11TH ST UNIT 4AS
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1965
Mailing Address - Country:US
Mailing Address - Phone:262-748-7569
Mailing Address - Fax:
Practice Address - Street 1:111 11TH ST UNIT 4AS
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1965
Practice Address - Country:US
Practice Address - Phone:262-748-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional