Provider Demographics
NPI:1588227961
Name:ELLIOTT, NATARA J (CCM, CADC, LPC)
Entity Type:Individual
Prefix:
First Name:NATARA
Middle Name:J
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CCM, CADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14736 JOSEPH PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BELOIT
Mailing Address - State:IL
Mailing Address - Zip Code:61080-2367
Mailing Address - Country:US
Mailing Address - Phone:815-601-1524
Mailing Address - Fax:
Practice Address - Street 1:14736 JOSEPH PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH BELOIT
Practice Address - State:IL
Practice Address - Zip Code:61080-2367
Practice Address - Country:US
Practice Address - Phone:815-601-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35439101YA0400X
IL4217714171M00000X
IL178.014802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator