Provider Demographics
NPI:1467878546
Name:ELLIOTT, ANNA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 N 15TH AVE
Mailing Address - Street 2:APT 8E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4023
Mailing Address - Country:US
Mailing Address - Phone:781-307-7776
Mailing Address - Fax:
Practice Address - Street 1:109 N ARTHUR AVE
Practice Address - Street 2:#203
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3105
Practice Address - Country:US
Practice Address - Phone:781-307-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health