Doctor Name: | PENNY ELLIOTT |
NPI Number: | 1083970818 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 3513 |
Business Practice Address: | 117 B St Sw Ardmore, OK - 734016401 |
Business Phone Number: | 5802263750 |
Business Fax Number: | 5802266470 |
Mailing Address: | 117 B St Sw, ARDMORE |
State: | OK |
Postal Code: | 734016401 |
Phone Number: | 5802263750 |
Fax Number: | 5802266470 |
NPI Enumeration Date: | 04/05/2012 |
NPI Last Update Date: | 04/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |