Provider Demographics
NPI:1386450898
Name:MCELHONE, MARY ELIZABETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MCELHONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:AZ
Mailing Address - Zip Code:86329-0283
Mailing Address - Country:US
Mailing Address - Phone:909-649-2953
Mailing Address - Fax:
Practice Address - Street 1:2890 S RANCHO PL
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:AZ
Practice Address - Zip Code:86329
Practice Address - Country:US
Practice Address - Phone:909-649-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA151727OtherLMFT