Provider Demographics
NPI:1407952724
Name:EASLEY, ELENA B (LPC MS)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:B
Last Name:EASLEY
Suffix:
Gender:F
Credentials:LPC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 OLD YORK ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:215-885-9700
Mailing Address - Fax:215-886-7678
Practice Address - Street 1:8302 OLD YORK ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-885-9700
Practice Address - Fax:215-886-7678
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC002647OtherLPC
355006OtherMHN