Healthcare Provider Details

I. General information

NPI: 1316065774
Provider Name (Legal Business Name): MARY ELWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 W NEWBERRY RD STE 1A
GAINESVILLE FL
32606-6725
US

IV. Provider business mailing address

PO BOX 248
LAKE GENEVA FL
32160-0248
US

V. Phone/Fax

Practice location:
  • Phone: 352-328-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: