Healthcare Provider Details

I. General information

NPI: 1801156724
Provider Name (Legal Business Name): CARLY RENAE ELMS M.ED., LMSW, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SE HILLSIDE DR
OAK GROVE MO
64075-9406
US

IV. Provider business mailing address

2100 N NOLAND RD
INDEPENDENCE MO
64050-1647
US

V. Phone/Fax

Practice location:
  • Phone: 816-560-3227
  • Fax: 816-625-1147
Mailing address:
  • Phone: 816-560-3227
  • Fax: 877-807-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255R0406X
TaxonomyBlind Rehabilitation Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2015031466
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: