MEDICARE: BERNARD PETER ELKON LPC

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	001239	GA

General Provider Information

NPI Number	:	1972739530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD PETER ELKON LPC

Provider Business Mailing Address
First Line	:	443 LAKESHORE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1747
Country	:	US
Telephone Number	:	404-314-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 COMMERCIAL DR SW STE C
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	404-314-3861
Fax Number	:

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

Provider Enumeration Date	:	06/09/2009
Last Update Date	:	06/09/2009

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Directions to “ BERNARD PETER ELKON LPC” Practice Location

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