Provider Demographics
NPI:1598243768
Name:SEMPLE, ELAINE CARMEL (LEP)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:CARMEL
Last Name:SEMPLE
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 S IRENA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5133
Mailing Address - Country:US
Mailing Address - Phone:310-613-7531
Mailing Address - Fax:
Practice Address - Street 1:1209 S IRENA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5133
Practice Address - Country:US
Practice Address - Phone:310-613-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-6820103K00000X
CA2789103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst