MEDICARE: DR. SCOTT KEITH ELMORE PSYD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C5235	OR

General Provider Information

NPI Number	:	1902095334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT KEITH ELMORE PSYD

Provider Business Mailing Address
First Line	:	388 STATE ST STE 985
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3866
Country	:	US
Telephone Number	:	503-383-1249
Fax Number	:	503-217-6526

Provider Business Practice Location Address
First Line	:	388 STATE ST STE 985
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3866
Country	:	US
Telephone Number	:	503-383-1248
Fax Number	:	503-217-6526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	03/04/2020

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Directions to “ DR. SCOTT KEITH ELMORE PSYD” Practice Location

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