Provider Demographics
NPI:1336277649
Name:ELBERN, ALYCE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALYCE
Middle Name:M
Last Name:ELBERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7640
Mailing Address - Country:US
Mailing Address - Phone:573-446-8990
Mailing Address - Fax:573-445-9090
Practice Address - Street 1:108 SOUTH HEATHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7640
Practice Address - Country:US
Practice Address - Phone:573-446-8990
Practice Address - Fax:573-445-9090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO940101YP2500X
OK730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional