Provider Demographics
NPI:1558950261
Name:ELLIOTT, LISA ANN (LMCHA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 NE FARMHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:HANSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98340-8807
Mailing Address - Country:US
Mailing Address - Phone:206-851-0192
Mailing Address - Fax:
Practice Address - Street 1:7770 NE FARMHOUSE LN
Practice Address - Street 2:
Practice Address - City:HANSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98340-8807
Practice Address - Country:US
Practice Address - Phone:206-851-0192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health