Provider Demographics
NPI:1134323124
Name:PTACEK, ELAINE VALETTA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:VALETTA
Last Name:PTACEK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 NORTH FRANKLIN
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2322
Mailing Address - Country:US
Mailing Address - Phone:785-460-7588
Mailing Address - Fax:785-460-2396
Practice Address - Street 1:270 NORTH FRANKLIN
Practice Address - Street 2:SUITE C
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2322
Practice Address - Country:US
Practice Address - Phone:785-460-7588
Practice Address - Fax:785-460-2396
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor