Provider Demographics
NPI:1003107236
Name:MCBROOM, ELMA KATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:ELMA
Middle Name:KATHERINE
Last Name:MCBROOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELMA
Other - Middle Name:KATHERINE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10213 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:MO
Mailing Address - Zip Code:63626-9521
Mailing Address - Country:US
Mailing Address - Phone:573-202-9790
Mailing Address - Fax:
Practice Address - Street 1:10213 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:MO
Practice Address - Zip Code:63626-9521
Practice Address - Country:US
Practice Address - Phone:573-202-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12487077OtherCAQH