Provider Demographics
NPI:1336481910
Name:ELLIOTT, MARISELA E (LCSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:MARISELA
Middle Name:E
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:CHELA
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LAC
Mailing Address - Street 1:300 STAFFORD LN STE 30248
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-2247
Mailing Address - Country:US
Mailing Address - Phone:970-399-5990
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD LN STE 30248
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2247
Practice Address - Country:US
Practice Address - Phone:970-399-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002107101YA0400X
NV7826-M104100000X, 104100000X
COCSW.099292571041C0700X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000210999Medicaid
CO9000173464Medicaid