Provider Demographics
NPI:1568615227
Name:SHIFLEA, ELANA E DAVIS (MS, LPA)
Entity Type:Individual
Prefix:MS
First Name:ELANA
Middle Name:E DAVIS
Last Name:SHIFLEA
Suffix:
Gender:F
Credentials:MS, LPA
Other - Prefix:
Other - First Name:E.
Other - Middle Name:
Other - Last Name:DAVIS SHIFLEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPA
Mailing Address - Street 1:642 S. ALASKA ST.
Mailing Address - Street 2:STE. 207
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6378
Mailing Address - Country:US
Mailing Address - Phone:907-746-1558
Mailing Address - Fax:907-746-1833
Practice Address - Street 1:642 S ALASKA ST
Practice Address - Street 2:STE. 207
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6342
Practice Address - Country:US
Practice Address - Phone:907-746-1558
Practice Address - Fax:907-746-1833
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA#346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA#346OtherPSYCHOLOGICAL ASSOCIATE LICENSE