Provider Demographics
NPI:1801156724
Name:ELMS, CARLY RENAE (MED, LMSW, CRC)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:RENAE
Last Name:ELMS
Suffix:
Gender:F
Credentials:MED, LMSW, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N NOLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-1647
Mailing Address - Country:US
Mailing Address - Phone:816-560-3227
Mailing Address - Fax:877-807-4544
Practice Address - Street 1:1605 SE HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9406
Practice Address - Country:US
Practice Address - Phone:816-560-3227
Practice Address - Fax:816-625-1147
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X, 225400000X, 2255R0406X, 225C00000X, 171M00000X
MO2015031466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator