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Individual

MRS. MARY M ELSETHAGEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
101 NW BOARDMAN AVE., BOARDMAN, OR 97818
(541) 481-2911
Mailing address
3002 S EDISON PL, KENNEWICK, WA 99338-2714

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C1782
LPC
OR
Enumeration date
07/30/2006
Last updated
11/04/2009
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