Provider Demographics
NPI:1407018724
Name:ELLIOTT, CLARK ROSS (MFT)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ROSS
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 LAGUNA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1465
Mailing Address - Country:US
Mailing Address - Phone:805-560-7690
Mailing Address - Fax:805-683-5634
Practice Address - Street 1:923 LAGUNA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1465
Practice Address - Country:US
Practice Address - Phone:805-560-7690
Practice Address - Fax:805-683-5634
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM FT 021362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist