Provider Demographics
NPI:1972398048
Name:WHITMORE, ELIZABETH ELAINE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELAINE
Last Name:WHITMORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALTA MIRA CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7670
Mailing Address - Country:US
Mailing Address - Phone:636-579-3463
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 1006
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1907
Practice Address - Country:US
Practice Address - Phone:314-925-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health