Provider Demographics
NPI:1932926631
Name:ELOISE ERASMUS PHD LLC
Entity type:Organization
Organization Name:ELOISE ERASMUS PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-850-0589
Mailing Address - Street 1:4141 OLD SIBLEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1996
Mailing Address - Country:US
Mailing Address - Phone:612-850-0589
Mailing Address - Fax:952-223-6159
Practice Address - Street 1:4141 OLD SIBLEY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1996
Practice Address - Country:US
Practice Address - Phone:612-850-0589
Practice Address - Fax:952-223-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)