Individual
ELENA D SHORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
285 E OREGON AVE, CRESWELL, OR 97426-9160
(541) 870-1122
Mailing address
PO BOX 732, CRESWELL, OR 97426-0732
(541) 870-1122
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
L5772
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019047
—
OR
Enumeration date
12/06/2010
Last updated
07/03/2014
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