Doctor Name: | CARISSA LYNN ELLIOTT |
NPI Number: | 1245413863 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHP |
License Number: | 3671 |
Business Practice Address: | 651 W 4th St Chadron, NE - 693372272 |
Business Phone Number: | 3084304273 |
Business Fax Number: | |
Mailing Address: | 281 Airport Rd, CHADRON |
State: | NE |
Postal Code: | 693376911 |
Phone Number: | 3084304273 |
Fax Number: | |
NPI Enumeration Date: | 12/06/2007 |
NPI Last Update Date: | 11/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3671 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |