Provider Demographics
NPI:1144062043
Name:ELMORE, KATIE L (LMSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 COMMUNICATION DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3672
Mailing Address - Country:US
Mailing Address - Phone:573-248-1196
Mailing Address - Fax:573-248-2159
Practice Address - Street 1:146 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3672
Practice Address - Country:US
Practice Address - Phone:573-248-1196
Practice Address - Fax:573-248-2159
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240178061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical