Provider Demographics
NPI:1508531468
Name:ELLIOTT, SOPHIE (CSW)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3164
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-3164
Mailing Address - Country:US
Mailing Address - Phone:435-640-5165
Mailing Address - Fax:
Practice Address - Street 1:1820 SIDEWINDER DR STE 100
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7563
Practice Address - Country:US
Practice Address - Phone:435-640-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical