Provider Demographics
NPI:1790055671
Name:ELMORE, MARK MILES (LMHC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:MILES
Last Name:ELMORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12B N UNIVERSITY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5205
Mailing Address - Country:US
Mailing Address - Phone:509-891-5900
Mailing Address - Fax:509-232-6646
Practice Address - Street 1:12B N UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5205
Practice Address - Country:US
Practice Address - Phone:509-891-5900
Practice Address - Fax:509-232-6646
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60387411101YM0800X
WALH 60387411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional