Healthcare Provider Details

I. General information

NPI: 1235581786
Provider Name (Legal Business Name): ELEMENTS COUNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MILLER ST SUITE 108
SANTA MARIA CA
93454-5205
US

IV. Provider business mailing address

301 S. MILLER SUITE 108
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-349-2255
  • Fax: 805-739-0237
Mailing address:
  • Phone: 805-349-2255
  • Fax: 805-739-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: SHERILYN YOUNG
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC, MCA, CSC
Phone: 805-349-2255