Provider Demographics
NPI:1255409199
Name:NESBIT, ELAINE M (MA LP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:NESBIT
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1709
Mailing Address - Country:US
Mailing Address - Phone:952-426-5039
Mailing Address - Fax:612-416-0257
Practice Address - Street 1:220 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2046
Practice Address - Country:US
Practice Address - Phone:507-724-8353
Practice Address - Fax:612-416-0257
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
797221025213OtherPREFERRED ONE
MN997752000Medicaid
MN9H009NEOtherBCBS
HP20386OtherHEALTH PARTNERS
6219029OtherUBH