Provider Demographics
NPI:1104693910
Name:BRANDY ELMORE LCSW COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:BRANDY ELMORE LCSW COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:309-201-5201
Mailing Address - Street 1:2810 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6234
Mailing Address - Country:US
Mailing Address - Phone:217-377-0546
Mailing Address - Fax:
Practice Address - Street 1:2103 E WASHINGTON ST STE 2F
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4365
Practice Address - Country:US
Practice Address - Phone:309-201-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty