Provider Demographics
NPI:1477004257
Name:SPAULDING, ELLIOT ROBERT (ACMHC)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:ROBERT
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S BLUFF ST
Mailing Address - Street 2:TOWER 1 STE 301
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3853
Mailing Address - Country:US
Mailing Address - Phone:858-442-9263
Mailing Address - Fax:
Practice Address - Street 1:619 S BLUFF ST
Practice Address - Street 2:TOWER 1 STE 301
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3853
Practice Address - Country:US
Practice Address - Phone:858-442-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT964499-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health