Provider Demographics
NPI:1194864876
Name:ELLIOT, ANN LORENE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LORENE
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MORLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2243
Mailing Address - Country:US
Mailing Address - Phone:660-269-9577
Mailing Address - Fax:660-269-9578
Practice Address - Street 1:215 S MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2243
Practice Address - Country:US
Practice Address - Phone:660-269-9577
Practice Address - Fax:660-269-9578
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0035251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical