MEDICARE: ELEMENTS COUNSELING GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency	CA
2	251V00000X	Voluntary or Charitable Agency	CA
3	101Y00000X	Counselor	CA

General Provider Information

NPI Number	:	1528411162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTS COUNSELING GROUP

Provider Business Mailing Address
First Line	:	301 S MILLER ST
Second Line	:	SUITE 108
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5205
Country	:	US
Telephone Number	:	805-349-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S MILLER ST
Second Line	:	SUITE 108
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5205
Country	:	US
Telephone Number	:	805-349-2255
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHERILYN YOUNG
Credential	:	LPCC, MCA, CSC
Telephone Number	:	805-349-2255

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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Directions to “ELEMENTS COUNSELING GROUP ” Practice Location

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