Provider Demographics
NPI:1821365891
Name:YOHO, ELISA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name:YOHO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 SUNTREE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7540
Mailing Address - Country:US
Mailing Address - Phone:321-749-2549
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7540
Practice Address - Country:US
Practice Address - Phone:321-749-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL912103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool