Provider Demographics
NPI:1902356728
Name:ERGLE, ELYSIA (LPC)
Entity Type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:ERGLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2156
Mailing Address - Country:US
Mailing Address - Phone:256-766-9804
Mailing Address - Fax:256-764-8444
Practice Address - Street 1:1801 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2156
Practice Address - Country:US
Practice Address - Phone:256-766-9804
Practice Address - Fax:256-764-8444
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional