Provider Demographics
NPI:1609325323
Name:ELLIOTT, BRENT STUART (CLNICAL PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:STUART
Last Name:ELLIOTT
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Gender:M
Credentials:CLNICAL PSYCHOLOGIST
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Mailing Address - Street 1:6353 CENTER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4112
Mailing Address - Country:US
Mailing Address - Phone:757-461-3313
Mailing Address - Fax:757-461-8363
Practice Address - Street 1:6353 CENTER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4112
Practice Address - Country:US
Practice Address - Phone:757-461-3313
Practice Address - Fax:757-461-8363
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
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Provider Licenses
StateLicense IDTaxonomies
VA0810005522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0810005522OtherLICENSE NUMBER