Provider Demographics
NPI:1578850673
Name:ELLIOTT, DEBRA A (LCSW, LCDC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CLAYTON LN
Mailing Address - Street 2:SUITE 242 WEST
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1066
Mailing Address - Country:US
Mailing Address - Phone:512-468-8498
Mailing Address - Fax:
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:SUITE 242, WEST
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-468-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical