Basic Information
| Provider Information | |||||||||
| NPI: | 1861522856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELMER | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 9TH STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078268633 | ||||||||
| FaxNumber: | 7078268628 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | ARCATE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078268610 | ||||||||
| FaxNumber: | 7078268623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT52969 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.