Provider Demographics
NPI:1922658558
Name:ELIZABETH CLEMONS MENTAL HEALTH COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:ELIZABETH CLEMONS MENTAL HEALTH COUNSELING SERVICES LLC
Other - Org Name:ELIZABETH CLEMONS MENTAL HEALTH COUNSELING SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:443-987-6404
Mailing Address - Street 1:5089 MOUNT IDA RD
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-4115
Mailing Address - Country:US
Mailing Address - Phone:443-987-6404
Mailing Address - Fax:443-914-2107
Practice Address - Street 1:5089 MOUNT IDA RD
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-4115
Practice Address - Country:US
Practice Address - Phone:443-987-6404
Practice Address - Fax:443-914-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922658558OtherELIZABETH CLEMONS MENTAL HEALTH COUNSELLING SERVICES, LLC.
1922658558OtherBCBCS- AL