Provider Demographics
NPI:1336310416
Name:CLEMMONS, ELLARETHA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ELLARETHA
Middle Name:
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 SKYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8345
Mailing Address - Country:US
Mailing Address - Phone:850-482-8374
Mailing Address - Fax:
Practice Address - Street 1:3545 SKYVIEW RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8345
Practice Address - Country:US
Practice Address - Phone:850-482-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health