Provider Demographics
NPI:1134260839
Name:ELDER, MICHAEL FRANKLIN (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANKLIN
Last Name:ELDER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAKSHMI RD.
Mailing Address - Street 2:
Mailing Address - City:OLGA
Mailing Address - State:WA
Mailing Address - Zip Code:98279-3400
Mailing Address - Country:US
Mailing Address - Phone:360-376-3255
Mailing Address - Fax:
Practice Address - Street 1:109 N BEACH RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8205
Practice Address - Country:US
Practice Address - Phone:360-376-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34896106H00000X
WALF 60169631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist