Provider Demographics
NPI:1811011992
Name:CUNNINGTON ELAM, LORI KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:KAY
Last Name:CUNNINGTON ELAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-1045
Mailing Address - Country:US
Mailing Address - Phone:541-206-2718
Mailing Address - Fax:541-636-3607
Practice Address - Street 1:1355 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3955
Practice Address - Country:US
Practice Address - Phone:541-206-2718
Practice Address - Fax:541-606-3607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL48371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL4837OtherOREGON STATE BOARD OF LICENSED SOCIAL WORKERS