Provider Demographics
NPI:1902095334
Name:ELMORE, SCOTT KEITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEITH
Last Name:ELMORE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 STATE ST STE 985
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3866
Mailing Address - Country:US
Mailing Address - Phone:503-383-1249
Mailing Address - Fax:503-217-6526
Practice Address - Street 1:388 STATE ST STE 985
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3866
Practice Address - Country:US
Practice Address - Phone:503-383-1248
Practice Address - Fax:503-217-6526
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional