Provider Demographics
NPI:1841200904
Name:ELLIOTT, PAMELA JO (LCPC NCC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JO
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCPC NCC
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:HOGGATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 OGLESBY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4616
Mailing Address - Country:US
Mailing Address - Phone:309-212-2496
Mailing Address - Fax:312-789-4373
Practice Address - Street 1:706 OGLESBY AVE STE 300
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4616
Practice Address - Country:US
Practice Address - Phone:309-212-3606
Practice Address - Fax:312-789-4373
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004957101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
22902OtherNBCC