Provider Demographics
NPI:1255683348
Name:GAUL, ELISE (MS, LPC, CT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:GAUL
Suffix:
Gender:F
Credentials:MS, LPC, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 VINE STREET, SUITE 110
Mailing Address - Street 2:ALTERNATIVE CHOICES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:610-368-5844
Mailing Address - Fax:
Practice Address - Street 1:319 VINE STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:610-368-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0005161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional