Provider Demographics
NPI:1376877860
Name:LONGRES, ELSA URSULA (LCSW, LCDC)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:URSULA
Last Name:LONGRES
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 JOSEPHINE HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5080
Mailing Address - Country:US
Mailing Address - Phone:719-579-0062
Mailing Address - Fax:
Practice Address - Street 1:WBG CLINIC
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09036
Practice Address - Country:US
Practice Address - Phone:49931-889-7768
Practice Address - Fax:49931-889-7772
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO740101Y00000X
TX7935101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UPIN:VAD000Medicare UPIN