Organization
EMOTIONAL HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LYLE G ELENKIWICH LICSW (MENTAL HEALTH PROVIDER)
(763) 242-9240
Entity
Organization
Contact information
Practice address
2311 146TH AVE NE, HAM LAKE, MN 55304-6408
(763) 242-9240
Mailing address
2311 146TH AVE NE, HAM LAKE, MN 55304-6408
(763) 242-9240
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
11797
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201055100
—
MN
Enumeration date
10/16/2007
Last updated
10/16/2007
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