Healthcare Provider Details

I. General information

NPI: 1891613063
Provider Name (Legal Business Name): ELISA DEMING YOST LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WHEATFIELD DR STE B
MILFORD PA
18337-7695
US

IV. Provider business mailing address

600 AVENUE K
MATAMORAS PA
18336-1529
US

V. Phone/Fax

Practice location:
  • Phone: 570-328-5405
  • Fax:
Mailing address:
  • Phone: 570-328-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020602
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01265200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: