Provider Demographics
NPI:1619909421
Name:LINDHORST, ELMA ADA (PMH/NP-C)
Entity Type:Individual
Prefix:MS
First Name:ELMA
Middle Name:ADA
Last Name:LINDHORST
Suffix:
Gender:F
Credentials:PMH/NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W MAPLEWOOD ST
Mailing Address - Street 2:APPARTMENT D
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2045
Mailing Address - Country:US
Mailing Address - Phone:270-444-8465
Mailing Address - Fax:270-443-7734
Practice Address - Street 1:2620 PERKINS DR
Practice Address - Street 2:VA MEDICAL CLINIC CBOC
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42201
Practice Address - Country:US
Practice Address - Phone:270-443-8198
Practice Address - Fax:270-443-7734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health