Provider Demographics
NPI:1073796983
Name:POWELL, ELISE (LMHC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6788 MASSACHUSETTS DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3836
Mailing Address - Country:US
Mailing Address - Phone:561-670-7839
Mailing Address - Fax:
Practice Address - Street 1:6788 MASSACHUSETTS DR
Practice Address - Street 2:SUITE #1
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3836
Practice Address - Country:US
Practice Address - Phone:561-670-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health