Provider Demographics
NPI:1982338919
Name:PAVLIS, ELISA NAOMI (LPC)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:NAOMI
Last Name:PAVLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 E TRAIL BLAZER DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5864
Mailing Address - Country:US
Mailing Address - Phone:208-559-8528
Mailing Address - Fax:
Practice Address - Street 1:3061 S MERIDIAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7962
Practice Address - Country:US
Practice Address - Phone:208-620-5399
Practice Address - Fax:208-576-6915
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional