Provider Demographics
NPI:1104043918
Name:ELLIOTT, LINDA ELAINE (MAED)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 PICCADILLY CIR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5078
Mailing Address - Country:US
Mailing Address - Phone:520-249-9461
Mailing Address - Fax:
Practice Address - Street 1:2349 PICCADILLY CIR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5078
Practice Address - Country:US
Practice Address - Phone:520-249-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool