Provider Demographics
NPI:1508282740
Name:ELLIOTT, AMANDA (RMA, CTTS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RMA, CTTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9135
Mailing Address - Country:US
Mailing Address - Phone:740-947-7726
Mailing Address - Fax:740-947-9354
Practice Address - Street 1:227 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9135
Practice Address - Country:US
Practice Address - Phone:740-947-7726
Practice Address - Fax:740-947-9354
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSH208254101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)