Provider Demographics
NPI:1588354583
Name:ELAM, JESSICA ANN (MED, LPCA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:ELAM
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 MEREDITH BR
Mailing Address - Street 2:
Mailing Address - City:ROYALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41464-8338
Mailing Address - Country:US
Mailing Address - Phone:606-792-9042
Mailing Address - Fax:
Practice Address - Street 1:4223 MEREDITH BR
Practice Address - Street 2:
Practice Address - City:ROYALTON
Practice Address - State:KY
Practice Address - Zip Code:41464-8338
Practice Address - Country:US
Practice Address - Phone:606-792-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional