Provider Demographics
NPI:1235262148
Name:ELLIOTT, GEORGE G (LMFT, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:G
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1177
Mailing Address - Country:US
Mailing Address - Phone:270-678-4801
Mailing Address - Fax:270-678-3866
Practice Address - Street 1:104 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1177
Practice Address - Country:US
Practice Address - Phone:270-678-4801
Practice Address - Fax:270-678-3866
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0195101YP2500X
MDLC3547101YP2500X
KY104707101YP2500X
1041C0700X
KY104933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical