Provider Demographics
NPI:1083025654
Name:ELLIOTT, JOHN (PC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 THORNBERRY CT STE 620
Mailing Address - Street 2:ADULT, CHILD, FAMILY COUNSELING OF MASON
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7818
Mailing Address - Country:US
Mailing Address - Phone:513-229-8386
Mailing Address - Fax:513-229-8385
Practice Address - Street 1:6400 THORNBERRY CT
Practice Address - Street 2:STE 620
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7818
Practice Address - Country:US
Practice Address - Phone:513-229-8386
Practice Address - Fax:513-229-8385
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional