Provider Demographics
NPI:1902179633
Name:ELKINS, MACI NIELSEN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MACI
Middle Name:NIELSEN
Last Name:ELKINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4660
Mailing Address - Country:US
Mailing Address - Phone:503-840-5349
Mailing Address - Fax:
Practice Address - Street 1:8196 SW HALL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6411
Practice Address - Country:US
Practice Address - Phone:503-567-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL57641041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health