Provider Demographics
NPI:1790055671
Name:ELMORE, MARK MILES (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:MILES
Last Name:ELMORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N. PINES RD, SUITE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037
Mailing Address - Country:US
Mailing Address - Phone:509-891-5900
Mailing Address - Fax:
Practice Address - Street 1:1120 N. PINES RD, SUITE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037
Practice Address - Country:US
Practice Address - Phone:509-891-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60387411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional