Healthcare Provider Details

I. General information

NPI: 1902263056
Provider Name (Legal Business Name): ELORA BINNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 LITTLEROCK RD. SW BDG 6
TUMWATER WA
98512
US

IV. Provider business mailing address

6334 LITTLEROCK RD. SW BDG 6
TUMWATER WA
98512
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7590
  • Fax: 360-704-7591
Mailing address:
  • Phone: 360-704-7590
  • Fax: 360-704-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60630887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: