Provider Demographics
NPI:1083151625
Name:ELLIOTT, KATHRYN LAWRENCE (LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LAWRENCE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 POPLAR AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4831
Mailing Address - Country:US
Mailing Address - Phone:901-302-9575
Mailing Address - Fax:
Practice Address - Street 1:6363 POPLAR AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4831
Practice Address - Country:US
Practice Address - Phone:901-302-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional