Provider Demographics
NPI:1972858702
Name:NILES THORNE, ELISA AMARIS (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:AMARIS
Last Name:NILES THORNE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:AMARIS
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2571 N TOLEDO BLADE BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9351
Mailing Address - Country:US
Mailing Address - Phone:407-270-2491
Mailing Address - Fax:
Practice Address - Street 1:2571 N TOLEDO BLADE BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9351
Practice Address - Country:US
Practice Address - Phone:407-270-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health