Provider Demographics
NPI:1235860438
Name:SELF, EMELIA CATHERINE EMANUEL (EDS)
Entity Type:Individual
Prefix:
First Name:EMELIA
Middle Name:CATHERINE EMANUEL
Last Name:SELF
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:EMELIA
Other - Middle Name:CATHERINE
Other - Last Name:EMANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:124 PAINTED HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2651
Mailing Address - Country:US
Mailing Address - Phone:314-662-3673
Mailing Address - Fax:
Practice Address - Street 1:124 PAINTED HORSE WAY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2651
Practice Address - Country:US
Practice Address - Phone:314-662-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool