Provider Demographics
NPI:1548433634
Name:BERNIE, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BERNIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12085 ROCK CREEK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2543
Mailing Address - Country:US
Mailing Address - Phone:530-889-6760
Mailing Address - Fax:
Practice Address - Street 1:11716 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3732
Practice Address - Country:US
Practice Address - Phone:530-889-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor