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NPI Code Detail

MEDICARE: STEPHANIE ELISE ELMORE PSYD

MEDICARE: STEPHANIE ELISE ELMORE PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103TC0700XClinical PsychologistPY60828639WA

General Provider Information

NPI Number : 1043765894
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ELISE ELMORE PSYD
Provider Business Mailing Address
First Line : 107 S DIVISION ST
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1510
Country : US
Telephone Number : 509-838-4651
Fax Number :
Provider Business Practice Location Address
First Line : 124 E SHORT AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99202-1555
Country : US
Telephone Number : 509-838-4651
Fax Number : 509-363-2762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2016
Last Update Date : 01/15/2020

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1316166390 — MRS. MARIAH LYNN RHODES MA
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1700131307 — ANTHONY WAYNE MCBRIDE MS
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1235552308 — SARAH CHRISTINE DAVISON MSW
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1043767049 — JENNIFER ALICE MANDIN LCISW
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