Provider Demographics
NPI:1306947650
Name:ELLIOTT, PATRICIA H (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:H
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-0893
Mailing Address - Country:US
Mailing Address - Phone:775-883-2982
Mailing Address - Fax:775-883-7872
Practice Address - Street 1:502 E JOHN ST
Practice Address - Street 2:UNIT F
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3078
Practice Address - Country:US
Practice Address - Phone:775-883-2982
Practice Address - Fax:775-883-7872
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2139COtherLICENSE