Provider Demographics
NPI:1790275436
Name:ELMORE, PAUL (MA, MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:ELMORE
Suffix:
Gender:M
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SE LAKE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2194
Mailing Address - Country:US
Mailing Address - Phone:503-863-4074
Mailing Address - Fax:
Practice Address - Street 1:6901 SE LAKE RD STE 4
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2194
Practice Address - Country:US
Practice Address - Phone:503-863-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4789101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor