Individual
PHYLLIS ELZEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
10700 SW BEAVERTON HILLSDALE HWY, SUITE 525, BEAVERTON, OR 97005-3019
(503) 241-2276
Mailing address
2850 SW CEDAR HILLS BLVD, #213, BEAVERTON, OR 97005-1354
(503) 241-2276
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
#721
OR
1041C0700X
Clinical Social Worker
Primary
#721
OR
1041S0200X
School Social Worker
#721
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EIN 27-0049633
US DEPARTMENT OF TREASURY
OR
Enumeration date
03/26/2009
Last updated
08/17/2009
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