Healthcare Provider Details

I. General information

NPI: 1447921549
Provider Name (Legal Business Name): JONATHAN ELIAS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 32ND ST
WEST PALM BEACH FL
33407-4811
US

IV. Provider business mailing address

511 32ND ST
WEST PALM BEACH FL
33407-4811
US

V. Phone/Fax

Practice location:
  • Phone: 561-309-0119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: