Provider Demographics
NPI:1760108591
Name:ELMORE, JALYN (LPC)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 DAVISVILLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1525
Mailing Address - Country:US
Mailing Address - Phone:267-546-7511
Mailing Address - Fax:
Practice Address - Street 1:519 DAVISVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1525
Practice Address - Country:US
Practice Address - Phone:267-546-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA014627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014627OtherLICENSE