Provider Demographics
NPI:1265579593
Name:ELMORE, JOHN PHILLIP (MFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILLIP
Last Name:ELMORE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2206
Mailing Address - Country:US
Mailing Address - Phone:530-243-3695
Mailing Address - Fax:
Practice Address - Street 1:3235 WINDING WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2206
Practice Address - Country:US
Practice Address - Phone:530-243-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist