Provider Demographics
NPI:1285090738
Name:ELLIOTT, KATHLEEN (LMHC 000874-1)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMHC 000874-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1512
Mailing Address - Country:US
Mailing Address - Phone:585-506-7191
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD
Practice Address - Street 2:BLDG 1 SUITE 311
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3250
Practice Address - Country:US
Practice Address - Phone:585-270-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000874-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health