Provider Demographics
NPI:1124367180
Name:ELLIOTT, ERICA (LPC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 TERRY LN NE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9499
Mailing Address - Country:US
Mailing Address - Phone:405-623-4075
Mailing Address - Fax:
Practice Address - Street 1:10316 CAROLYN DR
Practice Address - Street 2:
Practice Address - City:NEWALLA
Practice Address - State:OK
Practice Address - Zip Code:74857-7605
Practice Address - Country:US
Practice Address - Phone:405-623-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional