Provider Demographics
NPI:1811052731
Name:ELLIOTT, PATRICIA S (MA LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 N JEFFERSON AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3391
Mailing Address - Country:US
Mailing Address - Phone:931-528-2371
Mailing Address - Fax:931-528-2376
Practice Address - Street 1:34 N JEFFERSON AVE
Practice Address - Street 2:STE A-1
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-528-2371
Practice Address - Fax:931-528-2376
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health