Provider Demographics
NPI:1356820237
Name:ELIOT, MADISON ROSE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:ELIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 SKY POINTE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4071
Mailing Address - Country:US
Mailing Address - Phone:702-704-5112
Mailing Address - Fax:186-663-3925
Practice Address - Street 1:6628 SKY POINTE DR STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4071
Practice Address - Country:US
Practice Address - Phone:702-704-5112
Practice Address - Fax:186-663-3925
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty