Provider Demographics
NPI:1841726452
Name:SEVERSON, ERAN
Entity type:Individual
Prefix:
First Name:ERAN
Middle Name:
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 BLUE JAY WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2218
Mailing Address - Country:US
Mailing Address - Phone:952-994-2239
Mailing Address - Fax:
Practice Address - Street 1:7101 YORK AVE S STE 317
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4469
Practice Address - Country:US
Practice Address - Phone:952-921-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2350101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health