Provider Demographics
NPI:1770094120
Name:DE VOS, ELANE
Entity type:Individual
Prefix:MRS
First Name:ELANE
Middle Name:
Last Name:DE VOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 E GRAYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9120
Mailing Address - Country:US
Mailing Address - Phone:801-448-1955
Mailing Address - Fax:
Practice Address - Street 1:835 E 4800 S STE 220
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5533
Practice Address - Country:US
Practice Address - Phone:801-262-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9623253-6010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health