Provider Demographics
NPI:1215465786
Name:ELITZUR, TAL SADAN (LCPC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TAL
Middle Name:SADAN
Last Name:ELITZUR
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:TALI
Other - Middle Name:S
Other - Last Name:ELITZUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10207 MCKENNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5003
Mailing Address - Country:US
Mailing Address - Phone:202-812-0008
Mailing Address - Fax:
Practice Address - Street 1:1680 E GUDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1360
Practice Address - Country:US
Practice Address - Phone:202-812-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14936101YM0800X
MDLC7871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health