Provider Demographics
NPI:1376968446
Name:ELMORE, DEBBIE M (LMFT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:M
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:LOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:95551-0619
Mailing Address - Country:US
Mailing Address - Phone:360-359-6427
Mailing Address - Fax:
Practice Address - Street 1:20 SHADOWBROOK STREET #619
Practice Address - Street 2:
Practice Address - City:LOLETA
Practice Address - State:CA
Practice Address - Zip Code:95551-0619
Practice Address - Country:US
Practice Address - Phone:360-359-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123020101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health