Provider Demographics
NPI:1255493896
Name:ELLIOT, JOSEPH PHILIP (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PHILIP
Last Name:ELLIOT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 MASSAC CREEK RD
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-3124
Mailing Address - Country:US
Mailing Address - Phone:270-841-0315
Mailing Address - Fax:618-524-9551
Practice Address - Street 1:2620 PERKINS CREEK DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7494
Practice Address - Country:US
Practice Address - Phone:270-444-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006415003OtherBCBS
133175100OtherOWCP
289899OtherMHN