Provider Demographics
NPI:1316569346
Name:ELLIOTT JR, G.W. BILL (MDIV)
Entity Type:Individual
Prefix:
First Name:G.W. BILL
Middle Name:
Last Name:ELLIOTT JR
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 LEGACY DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6201
Mailing Address - Country:US
Mailing Address - Phone:512-777-1034
Mailing Address - Fax:
Practice Address - Street 1:3911 LEGACY DR NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-6201
Practice Address - Country:US
Practice Address - Phone:512-777-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor