Provider Demographics
NPI:1558544411
Name:GATES, ELISE SUSAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:SUSAN
Last Name:GATES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 NE 35TH STREET
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306
Mailing Address - Country:US
Mailing Address - Phone:954-581-9006
Mailing Address - Fax:
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:#402
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-581-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health