Provider Demographics
NPI:1295011443
Name:HARPER, ELYSE ROSE (MFCS, LMFT/TEMP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:ROSE
Last Name:HARPER
Suffix:
Gender:F
Credentials:MFCS, LMFT/TEMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VALLEY WEST DR
Mailing Address - Street 2:302
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1908
Mailing Address - Country:US
Mailing Address - Phone:515-267-1340
Mailing Address - Fax:515-267-1355
Practice Address - Street 1:1200 VALLEY WEST DR
Practice Address - Street 2:302
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1908
Practice Address - Country:US
Practice Address - Phone:515-267-1340
Practice Address - Fax:515-267-1355
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist