Provider Demographics
NPI:1407376999
Name:ELICK, EMILIE LENORA (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:LENORA
Last Name:ELICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ALDEN DRIVE
Mailing Address - Street 2:BLDG 160
Mailing Address - City:F.E. WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-3913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DRIVE
Practice Address - Street 2:BLDG 160
Practice Address - City:F.E. WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3913
Practice Address - Country:US
Practice Address - Phone:307-773-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical